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Review of various liver retraction techniques in single incision laparoscopic surgery for the exposure of hiatus.

Palanivelu P, Patil KP, Parthasarathi R, Viswambharan JK, Senthilnathan P, Palanivelu C - J Minim Access Surg (2015 Jul-Sep)

Bottom Line: The main aspect of concern for upper GI procedures has been the retraction of the liver especially large left lobes as commonly encountered in Bariatric surgery.The average time to create the liver retraction was 2.8 to 8.6 min.There was no procedure related morbidity or mortality.The mentioned liver retraction techniques are cost effective and easy to learn.

View Article: PubMed Central - PubMed

Affiliation: Department of Bariatric Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India.

ABSTRACT

Background: The main aspect of concern for upper GI procedures has been the retraction of the liver especially large left lobes as commonly encountered in Bariatric surgery. Not doing so would compromise the view of the hiatus, hence theoretically reducing the quality of the surgery and increasing the possibility of complications. The aim of this study was to review the various liver retraction techniques in single incision surgery being done at our institute and analyze them.

Material and methods: A retrospective study of the various techniques and a subsequent analysis was made based on advantages and disadvantages of each method. Objectively a quantitative measure of hiatal exposure was done using a scoring system based on the grade of exposure after reviewing the surgical videos. From January 2011 to January 2013 total 104 patients underwent single incision surgery with the various liver retraction techniques with following grades of exposure -liver suspension tube technique with naso gastric tubing (2.11) and with corrugated drain (2.09) needlescopic method (1.2), Umbilical tape sling (1.95), crural stitch method (2.5). Needeloscopic method has the best grade of exposure and is the easiest to start with. The average time to create the liver retraction was 2.8 to 8.6 min.There was no procedure related morbidity or mortality.

Conclusions: The mentioned liver retraction techniques are cost effective and easy to learn. We recommend using these techniques to have a good exposure of hiatus, without compromising the safety of surgery in single incision surgery.

No MeSH data available.


Related in: MedlinePlus

Retraction with 3 mm instrument
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Figure 4: Retraction with 3 mm instrument

Mentions: A needloscopic instrument can be used through a 3.5 mm needle trocar (Karl Storz™, Germany) as shown in Figure 4, which can lift the left lobe. Alternatively a 2.3 mm alligator grasper (Stryker™, USA) can be used. One needs to be cautious using this instrument considering the sharp tipped nature of the instrument. This is especially applicable in large fatty livers where in the other techniques may be difficult to perform. These skin punctures heal without leaving behind a significant scar.


Review of various liver retraction techniques in single incision laparoscopic surgery for the exposure of hiatus.

Palanivelu P, Patil KP, Parthasarathi R, Viswambharan JK, Senthilnathan P, Palanivelu C - J Minim Access Surg (2015 Jul-Sep)

Retraction with 3 mm instrument
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4499926&req=5

Figure 4: Retraction with 3 mm instrument
Mentions: A needloscopic instrument can be used through a 3.5 mm needle trocar (Karl Storz™, Germany) as shown in Figure 4, which can lift the left lobe. Alternatively a 2.3 mm alligator grasper (Stryker™, USA) can be used. One needs to be cautious using this instrument considering the sharp tipped nature of the instrument. This is especially applicable in large fatty livers where in the other techniques may be difficult to perform. These skin punctures heal without leaving behind a significant scar.

Bottom Line: The main aspect of concern for upper GI procedures has been the retraction of the liver especially large left lobes as commonly encountered in Bariatric surgery.The average time to create the liver retraction was 2.8 to 8.6 min.There was no procedure related morbidity or mortality.The mentioned liver retraction techniques are cost effective and easy to learn.

View Article: PubMed Central - PubMed

Affiliation: Department of Bariatric Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India.

ABSTRACT

Background: The main aspect of concern for upper GI procedures has been the retraction of the liver especially large left lobes as commonly encountered in Bariatric surgery. Not doing so would compromise the view of the hiatus, hence theoretically reducing the quality of the surgery and increasing the possibility of complications. The aim of this study was to review the various liver retraction techniques in single incision surgery being done at our institute and analyze them.

Material and methods: A retrospective study of the various techniques and a subsequent analysis was made based on advantages and disadvantages of each method. Objectively a quantitative measure of hiatal exposure was done using a scoring system based on the grade of exposure after reviewing the surgical videos. From January 2011 to January 2013 total 104 patients underwent single incision surgery with the various liver retraction techniques with following grades of exposure -liver suspension tube technique with naso gastric tubing (2.11) and with corrugated drain (2.09) needlescopic method (1.2), Umbilical tape sling (1.95), crural stitch method (2.5). Needeloscopic method has the best grade of exposure and is the easiest to start with. The average time to create the liver retraction was 2.8 to 8.6 min.There was no procedure related morbidity or mortality.

Conclusions: The mentioned liver retraction techniques are cost effective and easy to learn. We recommend using these techniques to have a good exposure of hiatus, without compromising the safety of surgery in single incision surgery.

No MeSH data available.


Related in: MedlinePlus