title: Systematic Review of Retraction Devices for Laparoscopic Surgery.
abstract: BACKGROUND
  Retraction plays a vital role in optimizing the field of vision in minimal-access surgery. As such, a number of devices have been marketed to aid the surgeon in laparoscopic retraction. This systematic review explores the advantages and disadvantages of the different instruments in order to aid surgeons and their institutions in selecting the appropriate device. Primary outcome measures include operation time, length of stay, use of staff, patient morbidity, ease of use, conversion rates to open surgery, and cost.
  
  
  METHODS
  Systematic literature searches were performed in MEDLINE, EMBASE, The Cochrane Library, Current Controlled Trials, and ClinicalTrials.gov. The search strategy focused on studies testing a retraction device. The selection process was based on a predefined set of inclusion and exclusion criteria. Data were then extracted and analyzed.
  
  
  RESULTS
  Out of 1360 papers initially retrieved, 12 articles were selected for data extraction and analysis. A total of 10 instruments or techniques were tested. Devices included the Nathanson's liver retractor, liver suspension tape, the V-List technique, a silicone disk with or without a snake retractor, the Endoloop, the Endograb, a magnetic retractor, the VaroLift, a laparoscope holder, and a retraction sponge. None of the instruments reported were associated with increased morbidity. No studies found increased rates of conversion to open surgery. All articles reported that the tested instruments might spare the use of an assistant during the procedure. It was not possible to determine the impact on length of stay or operation time.
  
  
  CONCLUSIONS
  Each analyzed device facilitates retraction, providing a good field of view while allowing reduced staff numbers and minimal patient morbidity. Due to economic and environmental advantages, reusable devices may be preferable to disposable instruments, although the choice must be primarily based on clinical judgement.
authors.affiliation: University of Leeds, Leeds, UK a.vargas-palacios@leeds.ac.uk.
authors.forename: Armando
authors.initials: A
authors.lastname: Vargas-Palacios
authors.affiliation: University of Leeds, Leeds, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Hulme
authors.affiliation: University of Leeds, Leeds, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Veale
authors.affiliation: Leeds Teaching Hospitals Trust, Leeds, UK.
authors.forename: Candice L
authors.initials: CL
authors.lastname: Downey
mesh_terms: D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation*; D013525:Surgical Instruments; D016896:Treatment Outcome
keywords: devices; laparoscopic; retraction; surgery