Liver retraction by double-sling suture for laparoscopic gastrectomy

Background: To provide an optimal operative view for upper abdominal laparoscopic surgery, we developed a liver retraction method using a double-sling suture (DSS). The current report describes this method and compares the clinical results with the liver puncture (LP) retraction method. Materials and Methods: The data and video recordings of patients who underwent laparoscopic gastrectomy for gastric adenocarcinoma by a single surgeon from May 2009 to October 2013 were retrospectively analyzed. Results: Of the 189 patients included, 73 underwent surgery with the DSS method, and 116 underwent surgery with the LP method. Both groups exhibited no complications directly related to liver retraction. Compared with the LP group, the DSS group had a higher American Society of Anesthesiologists' physical status score, shorter operation time (153.2±42.1 minutes versus 224.8±83.3 minutes [P<.001]), shorter liver retraction time (200.1±76.8 seconds versus 231.4±97.5 seconds [P=.023]), and less elevation of activities of liver enzymes. Conclusions: Our DSS liver retraction method provided rapid and safe liver retraction for laparoscopic gastrectomy compared with the LP method. This method should also be useful for other laparoscopic upper abdominal surgery requiring liver retraction.