title: A novel totally internal laparoscopic liver retractor.
abstract: BACKGROUND
  Minimally invasive surgery is still in evolution. Throughout the past two decades numerous devices have been developed to enable safer and faster procedures, including anastomosis creating devices, energy sources, and superior imaging. However, retraction capabilities were put aside and currently, organ laparoscopic retraction is based on standard laparoscopic tools. In the era of minimizing the number of ports and shrinking their size, our aim was to develop internal retraction device that could be placed in the peritoneal cavity through a standard trocar, positioned for adequate retraction, and left in place for the entire procedure. These devices would obviate the need for inserting ports dedicated for retraction only and hence contribute to the reduction of the number of incisions. Herein, we present our initial experience with a novel internal liver retractor.
  
  
  METHODS
  The Endolift retractor is a simple telescopic rod that has anchoring claws at each end. It can be inserted using 5 mm standard trocar using a dedicated applier and anchored to the peritoneum beside the liver edges thereby lifting the undersurface of the liver and exposing the organs underneath. To achieve retraction of the left lateral segment, the Endolift retractor is anchored lateral to the right diaphragmatic crus on 1 side and lateral to the falciform ligament on the other.
  
  
  RESULTS
  A total of 14 operations were performed using the Endolift retractor for liver retraction including antireflux procedure, robotic-assisted Heller's myotomy, bariatric procedures, and bile duct exploration. The left lobe of the liver was adequately retracted and enabled access to the operating field. Repositioning was easily performed with progression of the surgery when necessary.
  
  
  CONCLUSIONS
  Internal retraction devices such as the Endolift retractor for liver retraction are one step further in minimizing trauma to the abdominal wall during minimal invasive surgery. It obviates the need for extra incisions, frees up the surgeons' hands, and may enable performing complicated laparo-endoscopic single-site laparoscopy and natural orifice transluminal endoscopic surgery.
authors.affiliation: Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Ram
authors.initials: R
authors.lastname: Elazary
authors.forename: Asaf
authors.initials: A
authors.lastname: Kedar
authors.forename: Noam
authors.initials: N
authors.lastname: Shussman
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Abu-Gazala
authors.forename: Abed
authors.initials: A
authors.lastname: Khalaileh
authors.forename: Mohammad
authors.initials: M
authors.lastname: Faroja
authors.forename: Avraham I
authors.initials: AI
authors.lastname: Rivkind
authors.forename: Yoav
authors.initials: Y
authors.lastname: Mintz
mesh_terms: D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation* / Q000379:methods; D008099:Liver; D013525:Surgical Instruments