Andres Hanssen, MD, FACS1, Sergio Plotnikov, MD, FACS2, Geylor Acosta, MD, FACS2, Jose G Haddad2, Diego A Hanssen, MD, FACS2, Rafael A Hanssen, MS2. 1Universidad Metropolitana, 2Instituto Médico La Floresta
Background: Retraction of the left lobe of the liver to allow adequate exposure of GE junction is crucial in most of laparoscopic bariatric procedures, the object of this study is to assess our initial experience using magnetic assisted liver retraction during laparoscopic gastric bypasses, and sleeve gastrectomies.
Methods: Fifty patients underwent bariatric procedures using a magnetic device (IMANLAP™) to intend elevate the left lobe of the liver during the procedure, a clamp attached to a 15cm polyethylene tube was placed in the upper left crus, the tube was passed under the left lobe of the liver and holed with another clamp attached to a small magnet, that was captured with a big external magnet attached to a flexible arm over the skin in the epigastrium or the right upper quadrant. In this group 36 procedures were sleeve gastrectomies (17 multiport, 9 single port and 10 reduced ports) and 14 were multiport gastric bypasses. The time employed to satisfactorily obtain adequate exposure with the magnetic system was compared with the time required to place a Nathanson´s retractor in fifty multiport bariatric procedures (26 sleeve gastrectomies and 24 gastric bypasses). Student independency test was used to compare the times required for liver retraction in both groups,
Results: Liver retraction was satisfactory in 34 out of the fifty patients (68%), in the remaining 16 cases a standard Nathanson´s retractor was inserted trough a 5mm subxiphoideal wound and the procedure was completed. The average time required for the installation of the magnetic assisted liver retraction was 289,28 seconds, with a standard deviation of 36,79 seconds (289,28 ± 36,79), for a minimum time of 230 seconds and a maximum of 372 with an amplitude of 142 sec.
The average time required to the complete installation of the Nathanson´s retractor was 206,28 second, with a standard deviation of 19,51 (206,28 ± 19,51), for a minimum time 171 seconds and a maximum of 239 with an amplitude of 68 sec.
The results of the inferential test were: t = 9,995, with 48 degrees of freedom and a bilateral significance of .000 (p < .01),
Mean BMI in the magnetic assisted retraction group was 44kg/M2 (30-48) and 48 Kg/m2 in the Nathanson´s group (34,9-52,6).
Conclusions: Magnetic assisted liver retraction during bariatric procedures is feasible in many cases and can avoid the wound necessary to insert a regular liver retractor. The installation of the magnetic retraction is more time consuming than the installation of a Nathanson´s retractor, but seems to be particularly useful in single or reduced ports bariatric procedures. The development of more powerful magnets for this purpose may contribute to make the liver retraction successful in patients with heavy steatotic livers and or thick abdominal walls.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 91053
Program Number: ETP867
Presentation Session: Emerging Technology iPoster Session (Non CME)
Presentation Type: Poster