Abstract
During bariatric surgery in morbidly obese patients, the surgeon’s operative view is often obscured by the hypertrophic fatty left lobe of the liver. The use of a conventional liver retractor mandates an additional subxiphoid wound, resulting in pain and scar formation, in addition to the risk of iatrogenic liver injury during retractor insertion. To overcome these limitations, we developed a simple, rapid, and safe technique for liver retraction—V-shaped liver suspension technique (V-LIST)—by using a Penrose drain and laparoscopic stapler. A silicone Penrose drain was inserted into the peritoneal cavity and stapled to the pars condensa of the lesser omentum and parietal peritoneum using a laparoscopic stapler. The left lobe of the liver was retracted by the V-shaped suspension. At the end of the surgery, the drain could be easily removed. In October 2009–February 2010, 14 patients underwent liver retraction with the use of this technique. We performed 12 Roux-en-Y gastric bypasses and 2 sleeve gastrectomies. This series also included three cases of single incision transumbilical laparoscopic surgery. The mean time required to complete the liver retraction was 8 min 21 s (range, 2–18 min 40 s). Retraction was appropriate in all patients, without the need for additional retractors or conversion. There were no V-LIST-related perioperative complications. Our V-LIST technique using a Penrose drain is safe and simple. It has potential applications in single incision laparoscopic bariatric procedures.
References
Nguyen NT, Longoria M, Gelfand DV, et al. Staged laparoscopic Roux-en-Y: a novel two-stage bariatric operation as an alternative in the super-obese with massively enlarged liver. Obes Surg. 2005;15:1077–81.
Pasenau J, Mamazza J, Schlachta CM, et al. Liver hematoma after laparoscopic Nissen fundoplication: a case report and review of retraction injuries. Surg Laparosc Endosc Percutan Tech. 2000;10:178–81.
Huang CK, Tsai JC, Lo CH, et al. Preliminary Surgical Results of Single-Incision Transumbilical Laparoscopic Bariatric Surgery. Obes Surg. 2010. doi:10.1007/s11695-009-0071-9.
Capizzi FD, Boschi S, Brulatti M, et al. Laparoscopic adjustable esophagogastric banding: preliminary results. Obes Surg. 2002;12:391–4.
Teixeira J, McGill K, Koshy N, et al. Laparoscopic single-site surgery for placement of adjustable gastric band—a series of 22 cases. Surg Obes Relat Dis. 2010;6:41–5.
Yassa NA, Peters JH. CT of focal hepatic injury due to surgical retractor. AJR Am J Roentgenol. 1996;166:599–602.
Sakaguchi Y, Ikeda O, Toh Y, et al. New technique for the retraction of the liver in laparoscopic gastrectomy. Surg Endosc. 2008;22:2532–4.
de la Torre RA, Satgunam S, Morales MP, et al. Transumbilical single-port laparoscopic adjustable gastric band placement with liver suture retractor. Obes Surg. 2009;19:1707–10.
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The authors declare that they have no conflict of interest.
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Huang, C.K., Lo, CH., Asim, S. et al. A Novel Technique for Liver Retraction in Laparoscopic Bariatric Surgery. OBES SURG 21, 676–679 (2011). https://doi.org/10.1007/s11695-010-0191-2
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DOI: https://doi.org/10.1007/s11695-010-0191-2