title: A percutaneous technique of liver retraction in laparoscopic bariatric & upper abdominal surgery.
abstract: BACKGROUND
  Laparoscopic bariatric surgery requires retraction of the left lobe of the liver to provide adequate exposure of the hiatus and the stomach. Currently used approaches utilize retractors that require additional incisions and prolong operative time.
  
  
  OBJECTIVE
  A retrospective evaluation of the efficacy and safety of a percutaneous liver retractor in a large series of patients undergoing laparoscopic bariatric surgery.
  
  
  METHODS
  Private practice, United States.
  
  
  METHODS
  A retrospective chart review was performed on 2601 patients undergoing bariatric surgery from January 2011 to September 2015. A percutaneously introduced grasper (Teleflex MiniLap Percutaneous Surgical System, Morrisville, NC) was used to retract the left lobe of the liver in all cases. The retractor could be repositioned as necessary by releasing and regrasping the diaphragm at different locations.
  
  
  RESULTS
  This technique was used in 2601 patients from January 2011 until September 2015. The average body mass index was 43.1 (range: 20.6-80.3). In all patients, this new method was found to be satisfactory to complete the bariatric procedure. The majority of procedures included laparoscopic Roux-en-Y gastric bypass, sleeve gastrectomy, and gastric band placement. No intraoperative liver injuries occurred with use of the Teleflex retractor.
  
  
  CONCLUSIONS
  Percutaneous retraction of the liver using the Teleflex MiniLap Percutaneous Surgical System was found to be safe and effective in this large series of morbidly obese patients. The rate of complications involving this technique is extremely low. This novel method provides safe and effective retraction with less trauma and better cosmesis than conventional technique.
authors.affiliation: Division of Advanced Laparoscopic and Bariatric Surgery, John T. Mather Memorial Hospital, Port Jefferson, New York.
authors.forename: Arif
authors.initials: A
authors.lastname: Ahmad
authors.affiliation: Division of Advanced Laparoscopic and Bariatric Surgery, John T. Mather Memorial Hospital, Port Jefferson, New York. Electronic address: jjarellano74@gmail.com.
authors.forename: Jason Jorge
authors.initials: JJ
authors.lastname: Arellano
authors.affiliation: Division of Advanced Laparoscopic and Bariatric Surgery, John T. Mather Memorial Hospital, Port Jefferson, New York.
authors.forename: Ashish
authors.initials: A
authors.lastname: Agarwala
authors.affiliation: Division of Advanced Laparoscopic and Bariatric Surgery, John T. Mather Memorial Hospital, Port Jefferson, New York.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Ahmad
authors.affiliation: Division of Advanced Laparoscopic and Bariatric Surgery, John T. Mather Memorial Hospital, Port Jefferson, New York.
authors.forename: Zoha
authors.initials: Z
authors.lastname: Ahmad
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000379:methods*; D015992:Body Mass Index; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008099:Liver; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D059351:Organ Sparing Treatments / Q000379:methods; D012189:Retrospective Studies; D055815:Young Adult
keywords: Bariatric surgery; Laparoscopic Roux-en-Y gastric bypass; Laparoscopic gastric band; Laparoscopic sleeve gastrectomy; Liver retraction