Background

Laparoscopic bariatric surgery requires retraction of the left lobe of the liver to provide adequate operative view and working space. Conventional approaches utilize a mechanical retractor that requires a dedicated incision, may cause liver damage, and often requires an assistant. This study evaluated the safety and efficacy of hands-free intracorporeal retractors in a large series of subjects undergoing laparoscopic bariatric surgery. This method eliminates the need for a subxiphoid incision, enables full surgeon autonomy, and allows for adjustments throughout the procedure. Methods

Retrospective chart review identified all subjects at a single hospital undergoing bariatric surgery between September 2017-March 2019 for whom suture-based liver retraction was selected. In this procedure, the left lobe of the liver was lifted by anchoring one fixed hook into the right crus and the two adjustable hooks into the insufflated abdominal wall to provide adjustable retraction of the left lobe of the liver. Results

In all, 527 cases were identified. Patients had a high rate of morbid obesity (80% with BMI >40 kg/m2) and most were female (84%). The most common bariatric procedures were Roux-en-Y gastric bypass (49.9%) and sleeve gastrectomy (49.1%). No injuries to the liver were noted. Only 2 procedures (0.4%) required more than 5 trocars and a subxiphoid incision. Three procedures (0.6%) required a second retractor. Conclusions

Suture-based liver retraction using the hands-free intracorporeal retractors was found to be safe and effective in this large case series of subjects with morbid obesity. No complications involving the technique were identified.