title: Minimizing hepatic trauma with a novel liver retraction method: a simple liver suspension using gauze suture.
abstract: BACKGROUND
  Prolonged liver retraction during radical gastrectomy for adequate exposure of the hepatogastric ligament may lead to hepatic trauma. The authors offer a new minimally traumatic liver retraction method using a simple liver suspension with a gauze suture and compare it with the modified liver-puncture method.
  
  
  METHODS
  This study retrospectively evaluated 92 patients who underwent the liver-suspension or liver-puncture method during gastric resections in 2010. Their clinical and operative characteristics were analyzed together with perioperative transaminases, and the two groups were compared. Patients with a history of liver disease, abnormal preoperative liver function test results, postoperative complications, or combined operations were excluded from the study. The liver-suspension method was performed using two 4 × 4-in. gauze pads threaded with a 2-0 Prolene suture, which were secured to the pars condensa with surgical clips and externally tied to suspend the liver toward the abdominal wall.
  
  
  RESULTS
  Each liver retraction was completed without intraoperative complications. The patients in the liver-suspension group had more nonhepatic comorbidities than those in the liver-puncture group (P = 0.029). Other patient characteristics such as age, gender, and body mass index (BMI) did not differ between the two groups. No differences were found between the groups in terms of mean operative time (200.3 ± 66.9 vs 214.9 ± 74.4) or preoperative mean alanine aminotransferase (ALT) or aspartate aminotransferase (AST) levels. However, the patients in the liver-suspension group had significantly lower postoperative mean ALT levels (postoperative days 0, 1, 2, 3, and 5) and mean AST levels (postoperative days 0 and 1).
  
  
  CONCLUSIONS
  Compared with the liver-puncture method, the authors' novel liver-suspension with suture-gauze technique is a safe and effective method for retracting the liver during laparoscopic and robotic upper abdominal surgeries.
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, 134 Shinchon-dong Seodaemun-ku, Seoul 120-752, Republic of Korea.
authors.forename: Yanghee
authors.initials: Y
authors.lastname: Woo
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Hyung
authors.forename: Hyoung-Il
authors.initials: HI
authors.lastname: Kim
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Obama
authors.forename: Taeil
authors.initials: T
authors.lastname: Son
authors.forename: Sung Hoon
authors.initials: SH
authors.lastname: Noh
mesh_terms: D000328:Adult; D000368:Aged; D004867:Equipment Design; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D008099:Liver / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012371:Robotics; D013525:Surgical Instruments; D013526:Surgical Mesh; D013536:Suture Techniques; D013537:Sutures