Low-Cost Incisionless Liver Retraction for Laparoscopic Sleeve Gastrectomy: A Prospective Controlled Trial

Laparoscopic bariatric surgery has been performed safely since 1991. In a persistent search for fewer and smaller scars, single port, needlescopic surgery, and other approaches have been implemented. Our goal was to analyze the safety and feasibility of using incisionless autostatic liver retraction for sleeve gastrectomy. Candidates for sleeve gastrectomy were selected, excluding those <18 and having had prior upper left quadrant surgery. Patients were randomized 1:1 to either a standard five-port technique with a fan-type liver retractor (Group A); or a four-port technique with the liver retracted using a polypropylene 1 suture passed through the right crura and retrieved at the epigastrium employing a fascial closure needle (Group B). All surgeries were performed by the same surgeon. The primary endpoint was surgery duration. Secondary outcomes were quality of surgical-field visualization, complications inherent to liver retraction, and postoperative morbidity. One hundred patients were recruited (n = 50/group). The groups (both 90% females) were demographically and anthropomorphically comparable. Surgery duration was 30.4 ± 4.6 and 29.6 ± 4.7 minutes for Groups A and B, respectively (P = .41). Visualization was considered very good in 80% versus 82%, good in 16% versus 12%, and poor in 4% versus 6% (P = NS). Two patients from each group (4%) had self-limited minor bleeding from the liver attributed to the retraction technique. No 30-day morbidity was observed. Liver retraction using a polypropylene suture was both effective and inexpensive. Visualization and the duration of surgery were comparable to a standard liver retractor. This low-cost alternative may diminish the need for expensive instruments and reduce the number of scars without jeopardizing the safety and quality of sleeve gastrectomy.