Hand assisted gauze retractor for right hepatic lobe mobilization

Due to lack of tactile feedback, available retractors might inadvertently cause traumatic injury to the liver, leading to unnecessary bleeding, especially in patients with bleeding diathesis. Hand-assisted retraction might also be less than ideal, either due to wrist fatigue leading to frequent change in magnitude and direction of traction, fear of undue tension on draining veins, fear of subcapsular tumor rupture, or simply due to slippery liver capsule. We devised a simple trick using a piece of gauze for safer mobilization of the right lobe; especially those bearing large subcapsular tumors. This maneuver offers better caval exposure, less IVC compression, less twisting on hilar pedicle, and less pressure on tumor-bearing hepatic parenchyma, thus, decreasing incidence of dissemination. Favorable results were obtained when this technique was applied on the large right lobes with long anteroposterior diameter and convex lateral surface like those bearing subcapsular tumors; however, no advantage was found in small firm cirrhotic liver. This technique allows adequate and prolonged surgical exposure with minimal wrist strain with flexible change of position allowing readjustment in either the tensile force or in the vector direction; however, impact on hemodynamics needs further assessment.