Daniel Guerron, MD2, John Rodriguez, MD1, Chan Park, MD2, Juan Alvarez, MD2, Kalman Bencsath, MD1, Matthew Kroh3, Dana Portenier, MD2. 2Duke University Health System, Department of Surgery, Division of Weight Loss and Metabolic Surgery, Durham, NC, USA, 1Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA, 3Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA – Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates
Objective of the technology: Retraction of the liver is required to ensure a suitable working space in laparoscopic bariatric surgery. The commercially available devices for liver retraction can impart morbidity including direct liver compression by the retraction force, and the need for an additional incision with subsequent potential complications such as infection, bleeding, and patient discomfort.
We have introduced a new technique using magnetic surgery searching to minimize patient invasiveness during bariatric procedures. We utilized a commercially available magnetic device (Levita Magnetics Surgical System) to suspend the liver for the performance of various bariatric procedures in order to show the clinical feasibility of the technique. This is an incisionless retraction which may reduce trauma while maintaining an appropriate surgical field exposure.
Description of the technology and method of its use or application: The system is comprised of an internal magnetic grasper with a detachable tip and an external magnetic controller. The grasper is designed in a similar shape and function as a regular laparoscopic grasper, provided with a delivery/retrieval shaft that allows for deployment of the detachable tip. The detachable grasper tip is secured to the left lateral segment of the liver, the external magnet is placed over the abdominal wall, and magnetic attraction allows for elevation of the liver. The external magnet can then be freely manipulated to create the desired exposure. At the end of the procedure, the external magnet is removed; the detachable grasper tip is recoupled to the magnetic grasper shaft and retrieved from the patient.
Preliminary results: The surgeries were performed in 2 academic centers, Duke University and Cleveland Clinic. 8 patients underwent laparoscopic bariatric procedures using the Levita Magnetics Surgical System for retraction of the liver. 3 LSG, 2 RYGB, 2 DS and 1 revisional. The BMI range was between 18.3 – 49.18 kg/m2. In all the cases the internal grasper was positioned on the border of the left lateral segment of the liver and connected with the external magnetic controller through the abdominal wall (figure 1). Under direct visualization, the external magnet was mobilized to obtain appropriate surgical exposure to complete the operations laparoscopically. No liver parenchymal damage was evident during the surgery. There were no complications attributable to the device. Surgeons described device deployment as technically simple and overall exposure as excellent
Conclusions / future directions: Magnetic surgery using the Levita Magnetics Surgical System enables to retract the liver with an incisionless technique that might reduce liver compression and access related complaints during laparoscopic bariatric procedures. Future studies should focus on objective benefits in larger series of patients.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 84396
Program Number: ET012
Presentation Session: Emerging Technology Session
Presentation Type: Podium
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