A sandwiching method that simplifies hepatic left lateral segment inversion to secure an optimal surgical view around the esophageal hiatus in laparoscopic and robotic gastrectomy for upper gastric and esophagogastric junction cancers

Hayami, Masaru; Makuuchi, Rie; Ida, Satoshi; Kumagai, Koshi; Ohashi, Manabu; Harada, Hiroki

doi:10.1007/s00423-023-02901-9

Langenbecks Arch Surg

2023

DOI: 10.1007/s00423-023-02901-9

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A sandwiching method that simplifies hepatic left lateral segment inversion to secure an optimal surgical view around the esophageal hiatus in laparoscopic and robotic gastrectomy for upper gastric and esophagogastric junction cancers

Masaru Hayami

Rie Makuuchi

Satoshi Ida

et al.

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Cited by 3 publications

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A case-series study of hepatic left lateral segment inversion for surgical field exposure in laparoscopic gastrectomy

Tian,

Cheng,

Shao

et al. 2024

BMC Surg

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Purpose Retraction of the hepatic left lateral segment (HLLS) is a crucial maneuver for surgical field exposure during laparoscopic gastrectomy with systematic lymphadenectomy. Though various methods of retraction are available, there is no perfect solution. Here, we report the results of our initial 42 cases with HLLS inversion method and discuss the feasibility, safety, effectiveness and technical aspects of this method. Methods The intraoperative and postoperative short-term outcomes of 42 patients who underwent HLLS inversion during laparoscopic total gastrectomy and proximal gastrectomy in our department September, 2023 to January, 2024 were reviewed. HLLS inversion was performed by mobilizing the HLLS and inverting it to the right supra-hepatic space through an incision at the falciform ligament. Results 42 patients underwent HLLS inversion successfully with an average time of 13.9 min. 7 patients needed re-inversion due to slipping back of the HLLS during operation. Optimal exposure of the surgical field was achieved in all patients. No intra-operative complications occurred, except for 1 patient presented with mild intraoperative hepatic hemorrhage requiring electrocoagulation for hemostasis. Alanine aminotransferase and glutamine aminotransferase elevated in some patients on postoperative day 1(POD1), but declined to preoperative levels on the 7th postoperative day. There were no Clavien-Dindo II grade or higher digestive complications after surgery. In 5 patients with preservation the hepatic branch of the vagus nerve, the contractile function of the gall bladder was intact or slightly impaired 2 weeks after operation. Conclusion For laparoscopic proximal gastrectomy (LPG) and laparoscopic total gastrectomy (LTG), HLLS inversion is a feasible method for optimizing visualization of the surgical field with preservation of the function of the hepatic branch of the vagus nerve. It is safe and acceptable as to the manipulation time. Re-inversion is easy and effective even in case of failure of inversion. HLLS inversion seems to be a promising technique for retraction of the liver during laparoscopic gastrectomy. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-024-02635-5.

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A case-series study of hepatic left lateral segment inversion for surgical field exposure in laparoscopic gastrectomy

Tian,

Cheng,

Shao

et al. 2024

BMC Surg

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Modified hepatic left lateral lobe inversion in laparoscopic proximal gastrectomy: An analysis of 13 cases

Lin,

Wu,

2024

World J Gastrointest Surg

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BACKGROUND In laparoscopic proximal gastrectomy (LPG), the prolapse of the hepatic left lateral lobe near the lesser curvature and esophageal hiatus can obstruct the field of vision and operation. Therefore, it is necessary to retract or obstruct the hepatic left lateral lobe to ensure a clear field of vision. AIM To investigate the safety and clinical efficacy of the modified hepatic left lateral lobe inversion technique for LPG. METHODS A retrospective analysis was conducted on the clinical data of 13 consecutive patients with early-stage upper gastric adenocarcinoma or adenocarcinoma of the esophagogastric junction treated with LPG from January to December 2023 at the Department of Gastrointestinal Surgery, Second Affiliated Hospital of Fujian Medical University. The modified hepatic left lateral lobe inversion technique was used to expose the surgical field in all patients, and short-term outcomes were observed. RESULTS In all 13 patients, the modified hepatic left lateral lobe inversion technique was successful during surgery without the need for re-retraction or alteration of the liver traction method. There were no instances of esophageal hiatus occlusion, eliminating the need for forceps to assist in exposure. There was no occurrence of intraoperative hepatic hemorrhage, hepatic vein injury, or hepatic congestion. No postoperative digestive complications of Clavien-Dindo grade ≥ II occurred within 30 days after surgery, except for a single case of pulmonary infection. Some patients experienced increases in alanine aminotransferase and aspartate aminotransferase levels on the first day after surgery, which significantly decreased by the third day and returned to normal by the seventh day after surgery. CONCLUSION The modified hepatic left lateral lobe inversion technique has demonstrated satisfactory results, offering advantages in terms of facilitating surgical procedures, reducing surgical trauma, and protecting the liver.

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Advancements in liver retraction techniques for laparoscopic gastrectomy

Daley,

Griffiths

2025

World J Gastrointest Surg

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Traditionally, liver retraction for laparoscopic gastrectomy is done via manual methods, such as the placement of retractors through the accessory ports and using a Nathanson retractor. However, these techniques often posed issues including extra abdominal incisions, risk of liver injury or ischaemia, and the potential for compromised visualization. Over the years, the development of innovative liver retraction techniques has significantly improved the safety and efficacy of laparoscopic gastrectomy and similar other hiatal procedures. This editorial will comment on the article by Lin et al , and compare this to the other liver retractor techniques available for surgeons and highlight the pros and cons of each technique of liver retraction.

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A sandwiching method that simplifies hepatic left lateral segment inversion to secure an optimal surgical view around the esophageal hiatus in laparoscopic and robotic gastrectomy for upper gastric and esophagogastric junction cancers

Cited by 3 publications

References 23 publications

A case-series study of hepatic left lateral segment inversion for surgical field exposure in laparoscopic gastrectomy

A case-series study of hepatic left lateral segment inversion for surgical field exposure in laparoscopic gastrectomy

Modified hepatic left lateral lobe inversion in laparoscopic proximal gastrectomy: An analysis of 13 cases

Advancements in liver retraction techniques for laparoscopic gastrectomy

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