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A novel liver retraction method in laparoscopic gastrectomy for gastric cancer

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Abstract

Background

Retracting the lateral liver segment during laparoscopic distal gastrectomy is important for achieving an optimal surgical field. However, excessive force may injure the liver, causing temporary abnormalities of liver function tests after laparoscopic surgery. We developed a new liver retraction method and assessed its safety and utility.

Patients and methods

We retrospectively analyzed records in our surgical database of consecutive surgical patients who underwent laparoscopic distal gastrectomy for early gastric cancer. We divided the 229 patients into two groups based on the liver retraction method used, either flexible liver retraction with clipping and suturing (FLICS) or the Nathanson retractor (NR). One-to-one propensity score matching was performed to match patients, resulting in the records of 53 pairs of cases extracted from the database. Operative and postoperative outcomes were assessed, including following the values of serum liver enzymes, total bilirubin, and C-reactive protein until postoperative day 30.

Results

There were no significant differences in patient characteristics or preoperative data in the two groups. The retraction method was not changed intraoperatively for any patients. The operative time was significantly shorter in the FLICS group, but the amount of bleeding did not differ. Liver injury was not observed as a result of liver retraction during surgery. In both groups, serum liver enzymes temporarily increased after surgery but improved rapidly thereafter. The postoperative increases in aspartate transaminase, alanine transaminase, and C-reactive protein levels were significantly lower in the FLICS than in the NR group. No serious complications associated with liver retraction were observed in either group.

Conclusions

Our new liver retraction technique provided an optimal surgical field without inducing liver dysfunction. It is a simple, safe, and effective liver retraction technique.

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Funding

No funding was received for this research.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Osaka International Cancer Institute, 3-1-69 Ohtemae, Chuo-ku, Osaka, 541-8567, Japan

    Yuki Ushimaru, Takeshi Omori, Yoshiyuki Fujiwara, Yuji Shishido, Yoshitomo Yanagimoto, Keijirou Sugimura, Kazuyoshi Yamamoto, Jeong-Ho Moon, Hiroshi Miyata, Masayuki Ohue & Masahiko Yano

Authors
  1. Yuki Ushimaru
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  2. Takeshi Omori
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  3. Yoshiyuki Fujiwara
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  4. Yuji Shishido
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  5. Yoshitomo Yanagimoto
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  6. Keijirou Sugimura
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  7. Kazuyoshi Yamamoto
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  8. Jeong-Ho Moon
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  9. Hiroshi Miyata
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  10. Masayuki Ohue
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  11. Masahiko Yano
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Corresponding author

Correspondence to Takeshi Omori.

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Disclosures

Drs. Yuki Ushimaru, Takeshi Omori, Yoshiyuki Fujiwara, Yuji Shishido, Yoshitomo Yanagimoto, Keijirou Sugimura, Kazuyoshi Yamamoto, Jeong-Ho Moon, Hiroshi Miyata, Masayuki Ohue, and Masahiko Yano have no conflicts of interest or financial ties to disclose.

Ethics statement

All procedures in this study were in accordance with the ethical standards of the responsible committee on institutional human experimentation and with the Helsinki Declaration of 1964 and later versions.

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Ushimaru, Y., Omori, T., Fujiwara, Y. et al. A novel liver retraction method in laparoscopic gastrectomy for gastric cancer. Surg Endosc 33, 1828–1836 (2019). https://doi.org/10.1007/s00464-018-6461-0

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