Magnetic Liver Retraction: an Incision-Less Approach for Less Invasive Bariatric Surgery
In bariatric surgery, retraction of the liver is essential to ensure appropriate visualization of the surgical field. Many devices are currently employed for this purpose. Generally, these devices require constant use of a port, or an additional incision. Magnetic technology provides a novel solution, by allowing liver retraction during bariatric procedures that do not require a dedicated port nor an extra incision.
Retrospective review of consecutive patients who underwent magnetic-assisted liver retraction during primary or revisional laparoscopic bariatric surgery at the Duke Center for Metabolic and Weight Loss Surgery between October 2016 and August 2017.
The 73 cases were comprised of 29 primary sleeve gastrectomies, 24 gastric bypasses, 10 duodenal switches, 3 gastric band removals, and 7 revisions. All cases were completed laparoscopically. Mean pre-operative BMI was 43.6 kg/m2 (range 18.3–67.7 kg/m2). Mean operative times for primary cases were similar to published averages. Two patients experienced minor 30-day morbidities, neither of which were attributed to the device and did not require further interventions. There were no 30-day mortalities. Surgeons described subjective overall surgical exposure as adequate and device utilization as technically simple even for the large livers.
Magnetic-assisted retraction is a novel approach that allows a safe, reproducible, incision-less technique for unconstrained, port-less intra-abdominal mobilization. The device successfully permitted optimal liver retraction during laparoscopic bariatric surgery, enhancing surgical exposure while decreasing the number of abdominal incisions.
KeywordsBariatric surgery Liver retraction Magnetic-assisted surgery Incision-less Laparoscopic
Compliance with Ethical Standards
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
Conflict of Interest
Gerardo Davalos, Camila Ortega, Scott Schimpke, Sugong Chen, Kunoor Jain-Spangler, and Ranjan Sudan have no conflicts of interest. Matthew Davis has no conflicts of interest relevant to this publication, but has received a consultation fee from Medtronic. Jin Yoo has no conflicts of interest relevant to this publication, but is a consultant and speaker for Novadaq, Stryker, and Gore, and is a consultant for Teleflex. Keri Seymour has no conflicts of interest relevant to this publication, but is a speaker for Gore and Medtronic, and is a consultant for Teleflex. Dana Portenier has received an education grant from Levita Magnetics, has received an education grant from Gore, is a consultant, has received a research grant from Medtronic, and is a consultant for Intuitive. Alfredo D Guerron is a consultant for Levita Magnetics and a speaker for Gore and Medtronic.
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