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, 郑荣寿, 张思维, 等. 2015年中国胃癌流行特征分析. 中华流行病学杂志, 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.	吴硕东, 姚殿波, 孙余田. 肝左外叶粘贴式悬吊在单孔腹腔镜左季肋区手术中的应用价值. 中华消化外科杂志, 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.	季刚, 卫江鹏, 李世森, 等. 腹腔镜胃癌手术中高位食管空肠吻合重点与难点. 中国实用外科杂志, 2023, 43(9): 997-1001.
8.	秦龙, 李婷. 肝脏悬吊技术在腹腔镜胃癌根治术中的应用. 临床外科杂志, 2020, 28(6): 557-559.
9.	胡建昆, 杨昆, 陈心足, 等. 顺向式模块化淋巴结清扫在腹腔镜胃癌手术中的应用. 中华胃肠外科杂志, 2017, 20(2): 200-206.
10.	董小玉, 陈筱羽, 朱煜, 等. 自制腹腔镜胃癌根治术中拨肝装置的应用和效果评价. 中华胃肠外科杂志, 2017, 20(8): 884-886.
11.	肖刚, 于宏. 单孔腹腔镜手术中肝脏牵拉方法的应用进展. 中国微创外科杂志, 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, 马臻, 汪学艳, 等. 腹腔镜下肝脏悬吊方法进展. 中华普通外科杂志, 2020, 35(2): 171-173.
14.	刘烺飚, 牛磊, 赵晓牧, 等. 体内W型悬吊肝左叶在腹腔镜胃手术中的应用价值. 中华普外科手术学杂志(电子版), 2022, 16(3): 275-278.
15.	廖新华, 车向明, 贾宗良, 等. 腹腔镜下迷走神经肝支保护降低远端胃癌根治术后胆囊结石发生率的临床疗效观察. 腹腔镜外科杂志, 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.	张波, 王楠, 乔庆, 等. “W”型自制肝左叶悬吊装置在全腹腔镜全胃切除术中的应用. 中华胃肠外科杂志, 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.	田利飞, 李泽雨, 赵旭, 等. 两种肝悬吊方法在腹腔镜胃癌根治术中应用的对比研究. 中华普通外科杂志, 2021, 36(4): 263-266.
22.	刘明, 梅祎军, 潘晓明. 肝左叶粘贴式悬吊在腹腔镜胃癌根治术中的应用. 中华胃肠外科杂志, 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.	中国研究型医院学会机器人与腹腔镜外科专业委员会, 中国医师协会内镜医师分会腹腔镜外科专业委员会, 中华医学会外科学分会腹腔镜与内镜外科学组. 胃癌4K腹腔镜手术操作标准专家共识(2020版). 中华消化外科杂志, 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, 郑荣寿, 张思维, 等. 2015年中国胃癌流行特征分析. 中华流行病学杂志, 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. 吴硕东, 姚殿波, 孙余田. 肝左外叶粘贴式悬吊在单孔腹腔镜左季肋区手术中的应用价值. 中华消化外科杂志, 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. 季刚, 卫江鹏, 李世森, 等. 腹腔镜胃癌手术中高位食管空肠吻合重点与难点. 中国实用外科杂志, 2023, 43(9): 997-1001.
8. 秦龙, 李婷. 肝脏悬吊技术在腹腔镜胃癌根治术中的应用. 临床外科杂志, 2020, 28(6): 557-559.
9. 胡建昆, 杨昆, 陈心足, 等. 顺向式模块化淋巴结清扫在腹腔镜胃癌手术中的应用. 中华胃肠外科杂志, 2017, 20(2): 200-206.
10. 董小玉, 陈筱羽, 朱煜, 等. 自制腹腔镜胃癌根治术中拨肝装置的应用和效果评价. 中华胃肠外科杂志, 2017, 20(8): 884-886.
11. 肖刚, 于宏. 单孔腹腔镜手术中肝脏牵拉方法的应用进展. 中国微创外科杂志, 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, 马臻, 汪学艳, 等. 腹腔镜下肝脏悬吊方法进展. 中华普通外科杂志, 2020, 35(2): 171-173.
14. 刘烺飚, 牛磊, 赵晓牧, 等. 体内W型悬吊肝左叶在腹腔镜胃手术中的应用价值. 中华普外科手术学杂志(电子版), 2022, 16(3): 275-278.
15. 廖新华, 车向明, 贾宗良, 等. 腹腔镜下迷走神经肝支保护降低远端胃癌根治术后胆囊结石发生率的临床疗效观察. 腹腔镜外科杂志, 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. 张波, 王楠, 乔庆, 等. “W”型自制肝左叶悬吊装置在全腹腔镜全胃切除术中的应用. 中华胃肠外科杂志, 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. 田利飞, 李泽雨, 赵旭, 等. 两种肝悬吊方法在腹腔镜胃癌根治术中应用的对比研究. 中华普通外科杂志, 2021, 36(4): 263-266.
22. 刘明, 梅祎军, 潘晓明. 肝左叶粘贴式悬吊在腹腔镜胃癌根治术中的应用. 中华胃肠外科杂志, 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. 中国研究型医院学会机器人与腹腔镜外科专业委员会, 中国医师协会内镜医师分会腹腔镜外科专业委员会, 中华医学会外科学分会腹腔镜与内镜外科学组. 胃癌4K腹腔镜手术操作标准专家共识(2020版). 中华消化外科杂志, 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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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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

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