Progress in technique for retraction of liver during laparoscopic radical gastrectomy for gastric cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Jinglin ^1,2,3 ,  WANG Mojin ^1,2 ,  CHEN Xinzu ^1,2,4

1. Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
3. Department of Gastrointestinal and Hernia Surgery, Yibin Second People’s Hospital (West China Yibin Hospital, Sichuan University), Yibin, Sichuan 644000, P. R. China;
4. Ya’an Cancer Prevention and Control Center / Department of Gastrointestinal, Breast, Thyroid Surgery, Ya’an People’s Hospital (West China Ya’an Hospital, Sichuan University), Ya’an, Sichuan 625000, P. R. China;

Corresponding?author：

WANG Mojin, Email: wangmojin2001@163.com; CHEN Xinzu, Email: chenxinzu@scu.edu.cn

Keywords：

radical gastrectomy; laparoscopic surgery; liver retraction

DOI：

10.7507/1007-9424.202403001

Video：

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Objective To systematically review the methods, characteristics, and indications of technique for retraction of liver and evaluate their application effects during the laparoscopic radical gastrectomy for gastric cancer, so as to provide reference for clinicians to choose the most suitable liver retraction method. Method The relevant research literature on the application of liver retraction method both domestically and internationally during the laparoscopic radical gastrectomy was reviewed and compared. Results The main liver retraction methods that were used both domestically and internationally included V-shaped retraction, W-shaped retraction, medical adhesive retraction, and liver dilator retraction. Among them, the V-shaped, W-shaped, and liver dilator retraction techniques had been improved according to the situation, but these retraction techniques had their own advantages and disadvantages and could not be completely replaced by each other. Conclusions Currently, there is no absolutely ideal retraction method that is simple, safe, and effective. The specific choice of liver retraction technology needs to be selected based on the patient’s specific physical conditions, considering the safety, effectiveness, and rationality of this method.

Citation： ZHANG Jinglin, WANG Mojin, CHEN Xinzu. Progress in technique for retraction of liver during laparoscopic radical gastrectomy for gastric cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(7): 876-880. doi: 10.7507/1007-9424.202403001 Copy

1.	王少明, 鄭榮壽, 張思維, 等. 2015年中國胃癌流行特征分析. 中華流行病學雜志, 2019, 40(12): 1517-1521.
2.	Kitano S, Iso Y, Moriyama M, et al. Laparoscopy-assisted Billroth Ⅰ gastrectomy. Surg Laparosc Endosc, 1994, 4(2): 146-148.
3.	Zhang S, Cui XM, Du T, et al. Application of a new retraction method in laparoscopic gastrectomy for gastric cancer. Surg Laparosc Endosc Percutan Tech, 2023, 33(4): 431-434.
4.	吳碩東, 姚殿波, 孫余田. 肝左外葉粘貼式懸吊在單孔腹腔鏡左季肋區手術中的應用價值. 中華消化外科雜志, 2018, 17(5): 497-501.
5.	Far SS, Miraj S. Single-incision laparoscopy surgery: a systematic review. Electron Physician, 2016, 8(10): 3088-3095.
6.	Lin T, Mou TY, Hu YF, et al. Reduced port laparoscopic distal gastrectomy with D2 lymphadenectomy. Ann Surg Oncol, 2018, 25(1): 246. doi: 10.1245/s10434-017-6066-1.
7.	季剛, 衛江鵬, 李世森, 等. 腹腔鏡胃癌手術中高位食管空腸吻合重點與難點. 中國實用外科雜志, 2023, 43(9): 997-1001.
8.	秦龍, 李婷. 肝臟懸吊技術在腹腔鏡胃癌根治術中的應用. 臨床外科雜志, 2020, 28(6): 557-559.
9.	胡建昆, 楊昆, 陳心足, 等. 順向式模塊化淋巴結清掃在腹腔鏡胃癌手術中的應用. 中華胃腸外科雜志, 2017, 20(2): 200-206.
10.	董小玉, 陳筱羽, 朱煜, 等. 自制腹腔鏡胃癌根治術中撥肝裝置的應用和效果評價. 中華胃腸外科雜志, 2017, 20(8): 884-886.
11.	肖剛, 于宏. 單孔腹腔鏡手術中肝臟牽拉方法的應用進展. 中國微創外科雜志, 2019, 19(1): 72-76.
12.	Shinohara T, Kanaya S, Yoshimura F, et al. A protective technique for retraction of the liver during laparoscopic gastrectomy for gastric adenocarcinoma: using a Penrose drain. J Gastrointest Surg, 2011, 15(6): 1043-1048.
13.	王博方, 馬臻, 汪學艷, 等. 腹腔鏡下肝臟懸吊方法進展. 中華普通外科雜志, 2020, 35(2): 171-173.
14.	劉烺飚, 牛磊, 趙曉牧, 等. 體內W型懸吊肝左葉在腹腔鏡胃手術中的應用價值. 中華普外科手術學雜志(電子版), 2022, 16(3): 275-278.
15.	廖新華, 車向明, 賈宗良, 等. 腹腔鏡下迷走神經肝支保護降低遠端胃癌根治術后膽囊結石發生率的臨床療效觀察. 腹腔鏡外科雜志, 2018, 23(10): 770-773.
16.	Wang CJ, Chao YJ, Sy ED, et al. A simple method of intracorporeal “W-shaped” liver retraction technique for minimally invasive gastric cancer surgery. Surg Laparosc Endosc Percutan Tech, 2019, 29(3): e24-e28. doi: 10.1097/SLE.0000000000000648.
17.	張波, 王楠, 喬慶, 等. “W”型自制肝左葉懸吊裝置在全腹腔鏡全胃切除術中的應用. 中華胃腸外科雜志, 2022, 25(4): 357-360.
18.	Lins RD, Gomes RC, Santos KS, et al. Use of cyanoacrylate in the coaptation of edges of surgical wounds. An Bras Dermatol, 2012, 87(6): 871-876.
19.	ASGE Technology Committee, Bhat YM, Banerjee S, et al. Tissue adhesives: cyanoacrylate glue and fibrin sealant. Gastrointest Endosc, 2013, 78(2): 209-215.
20.	Sohn JJ, Gruber TM, Zahorsky-Reeves JL, et al. Comparison of 2-ethyl-cyanoacrylate and 2-butyl-cyanoacrylate for use on the calvaria of CD1 mice. J Am Assoc Lab Anim Sci, 2016, 55(2): 199-203.
21.	田利飛, 李澤雨, 趙旭, 等. 兩種肝懸吊方法在腹腔鏡胃癌根治術中應用的對比研究. 中華普通外科雜志, 2021, 36(4): 263-266.
22.	劉明, 梅祎軍, 潘曉明. 肝左葉粘貼式懸吊在腹腔鏡胃癌根治術中的應用. 中華胃腸外科雜志, 2016, 19(3): 343-344.
23.	Wu S, Yu H, Fan Y, et al. Liver retraction using n-butyl-2-cyanoacrylate glue during single-incision laparoscopic upper abdominal surgery. Br J Surg, 2014, 101(5): 546-549.
24.	Kitajima T, Shinohara H, Haruta S, et al. Prevention of transient liver damage after laparoscopic gastrectomy via modification of the liver retraction technique using the Nathanson liver retractor. Asian J Endosc Surg, 2015, 8(4): 413-418.
25.	Gojayev A, Yüksel C, Mercan ü, et al. The effect and clinical significance of using Nathanson liver retractor on liver function tests in laparoscopic gastric cancer surgery. Pol Przegl Chir, 2021, 94(1): 54-61.
26.	Sano A, Saito K, Kuriyama K, et al. Risk factors for postoperative liver enzyme elevation after laparoscopic gastrectomy for gastric cancer. In Vivo, 2021, 35(2): 1227-1234.
27.	Orr KE, Williams MP. MDCT of retractor-related hepatic injury following laparoscopic surgery: appearances, incidence, and follow-up. Clin Radiol, 2014, 69(6): 606-610.
28.	Tamhankar AP, Kelty CJ, Jacob G. Retraction-related liver lobe necrosis after laparoscopic gastric surgery. JSLS, 2011, 15(1): 117-121.
29.	Kinjo Y, Okabe H, Obama K, et al. Elevation of liver function tests after laparoscopic gastrectomy using a Nathanson liver retractor. World J Surg, 2011, 35(12): 2730-2738.
30.	Hiramatsu K, Aoba T, Kamiya T, et al. Novel use of the Nathanson liver retractor to prevent postoperative transient liver dysfunction during laparoscopic gastrectomy. Asian J Endosc Surg, 2020, 13(3): 293-300.
31.	Takemura M, Ikebe T, Mayumi K, et al. A novel liver retraction technique for lateral lobe of the liver during laparoscopic surgery using silicone disk. J Laparoendosc Adv Surg Tech A, 2011, 21(8): 729-732.
32.	Saeki H, Oki E, Kawano H, et al. Newly developed liver-retraction method for laparoscopic gastric surgery using a silicone disc: the φ-shaped technique. J Am Coll Surg, 2013, 216(5): e43-e46. doi: 10.1016/j.jamcollsurg.2013.02.005.
33.	Hachiya O, Sato T, Toda M, et al. An easy and safe method of liver retraction using a silicone disc and needle forceps for laparoscopic gastrectomy. J Laparoendosc Adv Surg Tech A, 2019, 29(4): 484-488.
34.	中國研究型醫院學會機器人與腹腔鏡外科專業委員會, 中國醫師協會內鏡醫師分會腹腔鏡外科專業委員會, 中華醫學會外科學分會腹腔鏡與內鏡外科學組. 胃癌4K腹腔鏡手術操作標準專家共識(2020版). 中華消化外科雜志, 2020, 19(s1): 1-10.
35.	Woo Y, Hyung WJ, Kim HI, et al. Minimizing hepatic trauma with a novel liver retraction method: a simple liver suspension using gauze suture. Surg Endosc, 2011, 25(12): 3939-3945.

1. 王少明, 鄭榮壽, 張思維, 等. 2015年中國胃癌流行特征分析. 中華流行病學雜志, 2019, 40(12): 1517-1521.
2. Kitano S, Iso Y, Moriyama M, et al. Laparoscopy-assisted Billroth Ⅰ gastrectomy. Surg Laparosc Endosc, 1994, 4(2): 146-148.
3. Zhang S, Cui XM, Du T, et al. Application of a new retraction method in laparoscopic gastrectomy for gastric cancer. Surg Laparosc Endosc Percutan Tech, 2023, 33(4): 431-434.
4. 吳碩東, 姚殿波, 孫余田. 肝左外葉粘貼式懸吊在單孔腹腔鏡左季肋區手術中的應用價值. 中華消化外科雜志, 2018, 17(5): 497-501.
5. Far SS, Miraj S. Single-incision laparoscopy surgery: a systematic review. Electron Physician, 2016, 8(10): 3088-3095.
6. Lin T, Mou TY, Hu YF, et al. Reduced port laparoscopic distal gastrectomy with D2 lymphadenectomy. Ann Surg Oncol, 2018, 25(1): 246. doi: 10.1245/s10434-017-6066-1.
7. 季剛, 衛江鵬, 李世森, 等. 腹腔鏡胃癌手術中高位食管空腸吻合重點與難點. 中國實用外科雜志, 2023, 43(9): 997-1001.
8. 秦龍, 李婷. 肝臟懸吊技術在腹腔鏡胃癌根治術中的應用. 臨床外科雜志, 2020, 28(6): 557-559.
9. 胡建昆, 楊昆, 陳心足, 等. 順向式模塊化淋巴結清掃在腹腔鏡胃癌手術中的應用. 中華胃腸外科雜志, 2017, 20(2): 200-206.
10. 董小玉, 陳筱羽, 朱煜, 等. 自制腹腔鏡胃癌根治術中撥肝裝置的應用和效果評價. 中華胃腸外科雜志, 2017, 20(8): 884-886.
11. 肖剛, 于宏. 單孔腹腔鏡手術中肝臟牽拉方法的應用進展. 中國微創外科雜志, 2019, 19(1): 72-76.
12. Shinohara T, Kanaya S, Yoshimura F, et al. A protective technique for retraction of the liver during laparoscopic gastrectomy for gastric adenocarcinoma: using a Penrose drain. J Gastrointest Surg, 2011, 15(6): 1043-1048.
13. 王博方, 馬臻, 汪學艷, 等. 腹腔鏡下肝臟懸吊方法進展. 中華普通外科雜志, 2020, 35(2): 171-173.
14. 劉烺飚, 牛磊, 趙曉牧, 等. 體內W型懸吊肝左葉在腹腔鏡胃手術中的應用價值. 中華普外科手術學雜志(電子版), 2022, 16(3): 275-278.
15. 廖新華, 車向明, 賈宗良, 等. 腹腔鏡下迷走神經肝支保護降低遠端胃癌根治術后膽囊結石發生率的臨床療效觀察. 腹腔鏡外科雜志, 2018, 23(10): 770-773.
16. Wang CJ, Chao YJ, Sy ED, et al. A simple method of intracorporeal “W-shaped” liver retraction technique for minimally invasive gastric cancer surgery. Surg Laparosc Endosc Percutan Tech, 2019, 29(3): e24-e28. doi: 10.1097/SLE.0000000000000648.
17. 張波, 王楠, 喬慶, 等. “W”型自制肝左葉懸吊裝置在全腹腔鏡全胃切除術中的應用. 中華胃腸外科雜志, 2022, 25(4): 357-360.
18. Lins RD, Gomes RC, Santos KS, et al. Use of cyanoacrylate in the coaptation of edges of surgical wounds. An Bras Dermatol, 2012, 87(6): 871-876.
19. ASGE Technology Committee, Bhat YM, Banerjee S, et al. Tissue adhesives: cyanoacrylate glue and fibrin sealant. Gastrointest Endosc, 2013, 78(2): 209-215.
20. Sohn JJ, Gruber TM, Zahorsky-Reeves JL, et al. Comparison of 2-ethyl-cyanoacrylate and 2-butyl-cyanoacrylate for use on the calvaria of CD1 mice. J Am Assoc Lab Anim Sci, 2016, 55(2): 199-203.
21. 田利飛, 李澤雨, 趙旭, 等. 兩種肝懸吊方法在腹腔鏡胃癌根治術中應用的對比研究. 中華普通外科雜志, 2021, 36(4): 263-266.
22. 劉明, 梅祎軍, 潘曉明. 肝左葉粘貼式懸吊在腹腔鏡胃癌根治術中的應用. 中華胃腸外科雜志, 2016, 19(3): 343-344.
23. Wu S, Yu H, Fan Y, et al. Liver retraction using n-butyl-2-cyanoacrylate glue during single-incision laparoscopic upper abdominal surgery. Br J Surg, 2014, 101(5): 546-549.
24. Kitajima T, Shinohara H, Haruta S, et al. Prevention of transient liver damage after laparoscopic gastrectomy via modification of the liver retraction technique using the Nathanson liver retractor. Asian J Endosc Surg, 2015, 8(4): 413-418.
25. Gojayev A, Yüksel C, Mercan ü, et al. The effect and clinical significance of using Nathanson liver retractor on liver function tests in laparoscopic gastric cancer surgery. Pol Przegl Chir, 2021, 94(1): 54-61.
26. Sano A, Saito K, Kuriyama K, et al. Risk factors for postoperative liver enzyme elevation after laparoscopic gastrectomy for gastric cancer. In Vivo, 2021, 35(2): 1227-1234.
27. Orr KE, Williams MP. MDCT of retractor-related hepatic injury following laparoscopic surgery: appearances, incidence, and follow-up. Clin Radiol, 2014, 69(6): 606-610.
28. Tamhankar AP, Kelty CJ, Jacob G. Retraction-related liver lobe necrosis after laparoscopic gastric surgery. JSLS, 2011, 15(1): 117-121.
29. Kinjo Y, Okabe H, Obama K, et al. Elevation of liver function tests after laparoscopic gastrectomy using a Nathanson liver retractor. World J Surg, 2011, 35(12): 2730-2738.
30. Hiramatsu K, Aoba T, Kamiya T, et al. Novel use of the Nathanson liver retractor to prevent postoperative transient liver dysfunction during laparoscopic gastrectomy. Asian J Endosc Surg, 2020, 13(3): 293-300.
31. Takemura M, Ikebe T, Mayumi K, et al. A novel liver retraction technique for lateral lobe of the liver during laparoscopic surgery using silicone disk. J Laparoendosc Adv Surg Tech A, 2011, 21(8): 729-732.
32. Saeki H, Oki E, Kawano H, et al. Newly developed liver-retraction method for laparoscopic gastric surgery using a silicone disc: the φ-shaped technique. J Am Coll Surg, 2013, 216(5): e43-e46. doi: 10.1016/j.jamcollsurg.2013.02.005.
33. Hachiya O, Sato T, Toda M, et al. An easy and safe method of liver retraction using a silicone disc and needle forceps for laparoscopic gastrectomy. J Laparoendosc Adv Surg Tech A, 2019, 29(4): 484-488.
34. 中國研究型醫院學會機器人與腹腔鏡外科專業委員會, 中國醫師協會內鏡醫師分會腹腔鏡外科專業委員會, 中華醫學會外科學分會腹腔鏡與內鏡外科學組. 胃癌4K腹腔鏡手術操作標準專家共識(2020版). 中華消化外科雜志, 2020, 19(s1): 1-10.
35. Woo Y, Hyung WJ, Kim HI, et al. Minimizing hepatic trauma with a novel liver retraction method: a simple liver suspension using gauze suture. Surg Endosc, 2011, 25(12): 3939-3945.

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Progress in technique for retraction of liver during laparoscopic radical gastrectomy for gastric cancer

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