Liver retraction by double-sling suture for laparoscopic gastrectomy

Area of Science:

• Minimally Invasive Surgery
• Surgical Techniques
• Gastrointestinal Surgery

Background:

• Optimal operative visualization is crucial for upper abdominal laparoscopic surgery.
• A novel double-sling suture (DSS) liver retraction method was developed.
• This study compares DSS with the established liver puncture (LP) method.

Purpose of the Study:

• To describe the double-sling suture (DSS) liver retraction technique.
• To compare the clinical outcomes of DSS versus liver puncture (LP) for laparoscopic gastrectomy.
• To evaluate the safety and efficacy of DSS in liver retraction.

Main Methods:

• Retrospective analysis of laparoscopic gastrectomy data from May 2009 to October 2013.
• Inclusion of 189 patients, with 73 undergoing DSS and 116 undergoing LP liver retraction.
• Data included operative time, liver retraction time, and liver enzyme levels.

Main Results:

• No complications directly related to liver retraction were observed in either group.
• The DSS group demonstrated significantly shorter operation times (153.2 vs. 224.8 minutes, P<.001).
• The DSS group also showed shorter liver retraction times (200.1 vs. 231.4 seconds, P=.023) and reduced liver enzyme elevation.

Conclusions:

• The DSS liver retraction method is rapid, safe, and effective for laparoscopic gastrectomy.
• DSS offers significant advantages over the LP method in terms of operative efficiency.
• The DSS technique is recommended for laparoscopic gastrectomy and potentially other upper abdominal surgeries requiring liver retraction.