Department of General Surgery, E-Da Hospital, 1 E-Da Road, Kaohsiung, Taiwan.
Obes Surg. 2011 May;21(5):676-9. doi: 10.1007/s11695-010-0191-2.
During bariatric surgery in morbidly obese patients, the surgeon's operative view is often obscured by the hypertrophic fatty left lobe of the liver. The use of a conventional liver retractor mandates an additional subxiphoid wound, resulting in pain and scar formation, in addition to the risk of iatrogenic liver injury during retractor insertion. To overcome these limitations, we developed a simple, rapid, and safe technique for liver retraction--V-shaped liver suspension technique (V-LIST)--by using a Penrose drain and laparoscopic stapler. A silicone Penrose drain was inserted into the peritoneal cavity and stapled to the pars condensa of the lesser omentum and parietal peritoneum using a laparoscopic stapler. The left lobe of the liver was retracted by the V-shaped suspension. At the end of the surgery, the drain could be easily removed. In October 2009-February 2010, 14 patients underwent liver retraction with the use of this technique. We performed 12 Roux-en-Y gastric bypasses and 2 sleeve gastrectomies. This series also included three cases of single incision transumbilical laparoscopic surgery. The mean time required to complete the liver retraction was 8 min 21 s (range, 2-18 min 40 s). Retraction was appropriate in all patients, without the need for additional retractors or conversion. There were no V-LIST-related perioperative complications. Our V-LIST technique using a Penrose drain is safe and simple. It has potential applications in single incision laparoscopic bariatric procedures.
在病态肥胖患者的减重手术中，外科医生的手术视野常常被肥大的左肝叶所遮挡。使用传统的肝脏牵开器需要额外的剑突下切口，这会导致疼痛和疤痕形成，此外在插入牵开器时还存在医源性肝损伤的风险。为了克服这些限制，我们开发了一种简单、快速、安全的肝脏牵开技术——V 形肝脏悬吊技术（V-LIST），该技术使用了硅胶引流管和腹腔镜吻合器。将硅胶 Penrose 引流管插入腹腔，使用腹腔镜吻合器将其缝合并固定在小网膜的Condensa 部和壁层腹膜上。通过 V 形悬吊将左肝叶牵拉。手术结束时，可以轻松地移除引流管。2009 年 10 月至 2010 年 2 月，我们使用该技术对 14 例患者进行了肝脏牵开。我们完成了 12 例 Roux-en-Y 胃旁路术和 2 例袖状胃切除术。这一系列手术还包括 3 例经脐单切口腹腔镜手术。完成肝脏牵开所需的平均时间为 8 分 21 秒（范围为 2-18 分 40 秒）。所有患者的牵开都合适，无需使用额外的牵开器或转为开腹手术。没有与 V-LIST 相关的围手术期并发症。我们使用 Penrose 引流管的 V-LIST 技术安全且简单。它在单切口腹腔镜减重手术中有潜在的应用价值。
