title: Clinical experience with a port-free internal liver retractor in laparoscopic bariatric surgery.
abstract: BACKGROUND
  As laparoscopic techniques and instrumentation advance, bariatric surgery has begun to be performed through smaller incisions and fewer ports. Since the visualization of the dorso-lateral portion of the left liver lobe is critical for most bariatric procedures, surgeons have developed various techniques for providing adequate liver retraction without compromising patient safety. Herein, we present our experience with a port-free internal liver retractor used for bariatric cases.
  
  
  METHODS
  Endolift™ does not require an additional port or anchoring to an external device. After insertion through an existing 5-mm port by means of the applier, one of the two attached clips (one on either end) was anchored to the left crus of the diaphragm while the other was fixed to the peritoneum above the right liver lobe through or beneath the falciform ligament. At the end of the surgery, the device was easily removed by using the applier.
  
  
  RESULTS
  We used this technique for 31 Roux-en-Y gastric bypasses and 2 single-incision sleeve gastrectomies. There were 24 females and 9 males with a mean age of 46 and mean body mass index 45.0 kg/m(2). The mean operative time was 136.5 min. The time required for the placement of the device was 1-3 min. The approach to the upper part of the stomach was satisfactory in all patients. No device-related complications were observed.
  
  
  CONCLUSIONS
  The internal liver retractor is easy to handle and provides adequate retraction and exposure for bariatric cases. It also has potential benefits for single-incision and reduced port laparoscopic procedures.
authors.affiliation: Bariatric and Metabolic Institute, M61, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA, hideharumaki@gmail.com.
authors.forename: Hideharu
authors.initials: H
authors.lastname: Shimizu
authors.forename: Esam
authors.initials: E
authors.lastname: Batayyah
authors.forename: Tomasz
authors.initials: T
authors.lastname: Rogula
mesh_terms: D050110:Bariatric Surgery / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation* / Q000379:methods; D008099:Liver; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*