Modified pulley maneuver to guide surgical plane in minimally invasive liver resection

Area of Science:

• Surgical Innovation
• Minimally Invasive Surgery
• Hepatobiliary Surgery

Background:

• Optimal liver traction is critical for safe parenchymal transection in minimally invasive liver surgery (MILS).
• Conventional pulley maneuvers using barbed sutures are costly and inflexible due to single-use materials and potential parenchymal damage.
• Minimally invasive liver surgery presents unique challenges, including limited instrument mobility and lack of tactile feedback, increasing the risk of iatrogenic injury.

Purpose of the Study:

• To develop and evaluate a modified pulley maneuver for improved liver traction in MILS.
• To create a more economical and versatile alternative to existing pulley techniques.
• To enhance the safety and efficiency of liver parenchymal transection.

Main Methods:

• A modified pulley maneuver was developed using barbed sutures with nonabsorbable polymer and metal clips.
• The metal clip secured the polymer clip, enabling suture reuse up to three times.
• Sutures were passed through the liver surface and anchored to the diaphragm or peritoneum, with tension adjusted by laparoscopic or robotic graspers.

Main Results:

• The modified pulley maneuver provided stable and adjustable liver traction.
• The use of clips allowed for suture reuse, significantly reducing costs.
• The technique facilitated optimal liver positioning for both open-pit and wedge-shaped resections.

Conclusions:

• The modified pulley maneuver is an economical, simple, and feasible technique for MILS.
• It offers stable liver traction, enhancing the versatility and safety of parenchymal transection.
• This method presents a cost-effective and adaptable solution for minimally invasive liver resections.