Atraumatic Liver Retraction Using Nelaton Catheters During Totally Laparoscopic Gastrectomy

Area of Science:

• Surgical Innovation
• Minimally Invasive Surgery
• Gastrointestinal Oncology

Background:

• Laparoscopic gastrectomy requires effective liver retraction for optimal surgical access.
• Traditional retractors may cause iatrogenic injury and prolonged recovery.
• Evaluating novel retraction techniques is crucial for improving patient outcomes.

Purpose of the Study:

• To introduce and evaluate a novel Nelaton catheter U-shaped retractor for liver retraction during laparoscopic gastrectomy.
• To compare the impact of Nelaton catheter retraction versus Nathanson retractors on postoperative recovery.

Main Methods:

• A comparative study involving 139 patients undergoing laparoscopic gastrectomy.
• Patients were divided into two groups: Nelaton catheter (n=57) and Nathanson retractor (n=82) for liver retraction.
• Serum liver enzymes (AST, ALT, CRP) and recovery variables (flatus, diet initiation, hospital stay) were monitored and compared.

Main Results:

• The Nelaton catheter group showed significantly lower levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and C-reactive protein (CRP) (P<0.001, P<0.001, P=0.007).
• Patients in the Nelaton catheter group experienced earlier first flatus (P=0.035), faster initiation of a soft diet (P=0.002), and shorter hospital stays (P=0.024).

Conclusions:

• Atraumatic liver retraction using Nelaton catheters is a safe and effective alternative in laparoscopic gastrectomy.
• This novel technique offers significant advantages in terms of reduced postoperative inflammation and accelerated patient recovery.