A novel totally internal laparoscopic liver retractor

Area of Science:

• Minimally invasive surgery
• Surgical instrumentation
• Laparoscopic surgery

Background:

• Minimally invasive surgery (MIS) continues to evolve with new devices for procedures.
• Current laparoscopic liver retraction relies on standard tools, often requiring dedicated ports.
• There's a need for devices that minimize abdominal wall trauma and reduce port count in MIS.

Purpose of the Study:

• To develop and evaluate a novel internal liver retractor for laparoscopic procedures.
• To reduce the number of incisions required for liver retraction in MIS.
• To provide adequate organ retraction without occupying additional ports.

Main Methods:

• The Endolift retractor, a telescopic rod with anchoring claws, was designed.
• It is inserted via a 5 mm standard trocar and anchored to the peritoneum near the liver.
• Specific anchoring points are used for retracting the left lateral segment of the liver.

Main Results:

• The Endolift retractor was used in 14 operations, including antireflux procedures, Heller's myotomy, bariatric surgery, and bile duct exploration.
• Adequate liver retraction was achieved, facilitating access to the surgical field.
• The retractor allowed for easy repositioning as needed during surgery.

Conclusions:

• Internal retraction devices like the Endolift retractor represent an advancement in minimizing abdominal wall trauma during MIS.
• This device obviates the need for extra incisions, freeing up surgeon's hands.
• It may facilitate complex procedures such as laparo-endoscopic single-site surgery and NOTES.