A flexible-arm liver retractor that provides an optimal surgical field without postoperative liver dysfunction.
OBJECTIVE
It is important to retract the lateral liver segment during laparoscopic gastrectomy to achieve an optimal surgical field. Few retractors cause transient liver dysfunction after surgery; therefore, for an easier and safer procedure, we devised a new liver retractor and implemented a trial clinical application.


METHODS
The novel liver retractor comprises a metallic, flexible arm retractor attached to the operating table and an air compressor which pneumatically moves and fixes the retractor. It was inserted directly into the abdominal cavity just below the xiphisternum to retract the left lobe of the liver anterosuperiorly, thereby exposing the hiatus. Blood samples were collected from the patients on days 1, 3, and 7 after surgery to assess the levels of the liver enzymes AST and ALT.


RESULTS
During laparoscopic gastrectomy, no liver damage was observed macroscopically. The surgical fields obtained were optimal and efficient for laparoscopic surgery. Notably, it was possible to retract the liver as often as needed. Further, none of the patients developed postoperative liver dysfunction.


CONCLUSIONS
The novel flexible-arm retractor provided an optimal surgical field without inducing liver dysfunction.
Hiroshi
H
Kawahira
Mikito
M
Mori
Hideki
H
Hayashi
Toshiyuki
T
Natsume
Takashi
T
Akai
Naoyuki
N
Hanari
Daisuke
D
Horibe
Koichi
K
Hayano
Hisahiro
H
Matsubara
D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D004796:Clinical Enzyme Tests; D004867:Equipment Design; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D007564:Japan; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation*; D008107:Liver Diseases / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008422:Materials Testing; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013525:Surgical Instruments; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase