Optimal exposure for hepatobiliary operations using the Bookwalter self-retaining retractor

Area of Science:

• Hepatobiliary surgery
• Surgical oncology
• Transplant surgery

Background:

• Increasing rates of hepatic resections and liver transplantation necessitate optimal liver exposure.
• Traditional approaches for posterior right lobe lesions often required thoracotomy.
• The Bookwalter retractor system has emerged as a valuable tool in abdominal surgery.

Purpose of the Study:

• To evaluate the efficacy of the Bookwalter retractor system for achieving adequate liver exposure during hepatic resections and liver transplantations.
• To determine if the Bookwalter retractor system can eliminate the need for thoracotomy in these procedures.

Main Methods:

• A retrospective review of over 158 hepatic resections and orthotopic liver transplantations.
• Utilized the Bookwalter retractor with a bilateral subcostal incision and midline extension to the xiphoid.
• Focused on specific technical details for optimal retractor system use.

Main Results:

• The Bookwalter retractor system provided outstanding exposure to all liver surfaces and upper abdominal quadrants.
• No thoracotomies were required in any of the procedures.
• Transient postoperative costal pain was minimal, with no significant complications reported.

Conclusions:

• The Bookwalter retractor system offers optimal, unobstructed exposure for hepatic operations, including resections and transplants.
• This system enhances patient safety and procedural efficiency while reducing manpower, time, and cost.
• It provides a versatile and safe alternative to thoracotomy for accessing all liver surfaces.