A Novel Liver Retraction Technique for Lateral Lobe of the Liver During Laparoscopic Surgery Using Silicone Disk

Abstract

For safe and effective laparoscopic surgery it is important to maintain a favorable view of the operative field. However, the use of a conventional liver retractor needs an additional wound and carries a risk for liver injury during surgery. We developed a novel retraction technique for the lateral lobe of the liver using a silicone disk (Hakko Co. Ltd.) during laparoscopic surgery. We used a silicone disk that consists of a silicone rubber membrane inside a flexible ring and four monofilament threads. The disk can be inserted into the abdomen under the pneumoperitoneum through a 12-mm port and is located at the dorsal side of the lateral lobe of the liver. The threads are withdrawn through the abdominal wall, two threads close to the infraxiphoid space and the other two threads bilaterally below the costal arch. Thus, the lateral lobe of the liver is safely raised to the ventral side and covered with a silicone membrane. We introduced this technique for various laparoscopic operations, such as gastrectomy, gastroplasty, and fundoplication. There were no complications related to the procedure. This retraction technique is easy, results in less liver damage, and provides an excellent operative view around the esophageal hiatus. The silicone membrane covering the lateral lobe reduces the risk of liver injury during surgery using laparoscopic forceps to a low level.