Matthew J Davis, MD, Camila B Ortega, MD, Dana Portenier, MD, Chan Park, MD, Ranjan Sudan, MD, Jin Yoo, MD, Keri Seymour, DO, Sugong Chen, MD, Scott Schimpke, MD, Alfredo D Guerron, MD. Duke University Health Center
Introduction: In laparoscopic bariatric surgery, retraction of the liver is essential to ensure appropriate visualization of the surgical field. Many devices currently employed for this purpose require constant use of a port and require an additional incision, which has the potential for bleeding or infection, and can contribute to the patient’s post-operative pain. We present a commercially available magnetic liver retractor employed during laparoscopic bariatric procedures that neither requires a dedicated port, nor an extra incision. We predict that this new technique will produce less trauma and related complications while maintaining suitable exposure.
Methods: Forty patients underwent primary or revisional laparoscopic bariatric surgery at the Duke Center for Metabolic and Weight Loss Surgery between October 2016 and August 2017. In all cases, the Levita Magnetics (San Mateo, California, USA) Surgical System was successfully employed for retraction of the liver. This system is comprised of an internal metallic grasper with a detachable tip that couples with an external magnet controller. The grasper is introduced through an existing 12-mm port at the end of a magnetized instrument and clamped to the edge of the liver. The external magnet is then placed over the external abdominal wall, is coupled to the grasper and magnetic attraction allows manipulation of the grasper to retract the liver. Once the procedure is completed, the external magnet is decoupled and the grasper tip is retrieved from the abdominal cavity using the introducer instrument.
Results: The 40 cases were comprised of 18 primary sleeve gastrectomies, 13 gastric bypasses, 3 duodenal switches, 2 gastric band removals and 4 revisions. All cases were completed laparoscopically. Mean pre-operative BMI was 43.3 kg/m2 (range 18.3 – 60.6 kg/m2). Mean operative time for primary cases was 101 minutes. Mean estimated blood loss and length of stay were 20 mL and 1.4 days, respectively. No immediate complications were attributed to the retractor device or the external magnet. Two patients experienced minor thirty-day morbidities, neither of which was attributed to the device and did not require further interventions. There were no thirty-day mortalities. Surgeons described exposure as excellent and device utilization as technically simple even for larger livers.
Conclusions: The Levita Magnetics Surgical System is an incision-less technique for liver retraction during laparoscopic surgery that provides adequate surgical field exposure without a cumbersome instrument. Its ability to retract even the largest of livers proves it should be considered a useful option for all minimally invasive procedures.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86722
Program Number: S055
Presentation Session: Instrumentation / Devices / Technologies Session
Presentation Type: Podium