Study of the usefulness of a novel gauze-rolled liver retractor in laparoscopic surgery

Nobuyuki Sakurazawa, MD1, Masao Miyashita, MD1, Sigeki Yokomuro, MD1, Satoshi Matsumoto, MD1, Akihisa Matsuda, MD1, Kazuya Yamahatsu, MD1, Junichiro Harada, Dr1, Tomohiko Yasuda, Dr1, Eiji Uchida, MD2. 1Nippon Medical School Chiba Hokusou Hospital, 2Nippon Medical School Hospital

[Introduction] Various techniques are used for retraction of the liver during laparoscopic surgery. Herein, we report the use of a novel retractor with the metal end covered with gauze so that the liver can be maintained in position via the friction force generated between the retractor surface and a minimal degree of liver damage is induced.

[Methods] For smooth passage through a 12-mm port, the retractor has a 5-cm long and 1-cm wide tip with two holes to fix the gauze. The angle of the tip can be adjusted from horizontal to vertical. In addition, the shaft has a small diameter (2.4 mm), resulting in the formation of only a small abdominal wall scar. Thirteen laparoscopic assisted distal gastrectomy (LADG) patients (10 males and 3 females) who underwent surgery using our retractor from October 2014 onwards (Group A) and 21 patients (12 males and 9 females) who underwent surgery using a Nathanson retractor from 2014 onwards (Group B) were compared in respect of the operation time, amount of bleeding, postoperative liver function and postoperative length of hospital stay (since postoperative severe liver dysfunction has occurred with the use of the Nathanson retractor in our hospital, the position of the retractor is changed every 15 minutes for relief of congestion; however, no intraoperative change of the retractor position for congestion relief is required with our gauze-rolled retractor).

[Results] There were no differences in the demographic characteristics between the two groups. In groups A and B, the operation times were 263.4 and 255.1 minutes (P = 0.62) and the amounts of bleeding were 109.6 and 74.8 g (P = 0.68), respectively. In regard to the postoperative liver function, the GOT values were 79.7 and 55.7 IU/L (P=0.12), the GPT values were 83.2 and 61.9 IU/L (P=0.29), the LDH value were 210.9 and 205.8 U/L (P=0.77) and the total bilirubin values were 0.98 and 1.04 mg/dL (P=0.71) respectively. The postoperative lengths of hospital stay were 12.2 and 13.6 days in Groups A and B, respectively (P = 0.25). Thus, there were no significant differences in the examined parameters between the two groups.

[Conclusions] The results suggest that use of the gauze-rolled liver retractor during laparoscopic surgery is useful, especially as it necessitates no position change for safety and congestion relief and leaves only a small scar on the abdominal wall.

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