K-Wire Retractor, a Trocar-Free Liver Retraction Technique in Bariatric Surgery
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ORIGINAL CONTRIBUTIONS
K-Wire Retractor, a Trocar-Free Liver Retraction Technique in Bariatric Surgery Xuejing Zheng 1 & Qing Sang 1 & Liang Wang 1 & Guanyang Chen 1 & Yifan Guo 1 & Qing Fan 1 & Dexiao Du 1 & Guangzhong Xu 1 & Dongbo Lian 1 & Bin Zhu 1 & Nengwei Zhang 1 & Zhipeng Sun 1 Received: 25 June 2020 / Revised: 26 October 2020 / Accepted: 26 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Liver retractor helps in the provision of an adequate operative field in bariatric surgery. Though several retractors have been introduced, an optimal retraction method is yet to be desired. We have developed a K-wire retractor, a simple trocarfree liver retractor used in our bariatric surgery. The efficacy and safety of the K-wire retractor were examined. Methods A retrospective review was performed on patients undergoing laparoscopic bariatric surgery from January 2016 to April 2019. Based on the application of liver retractors during surgery, patients were divided into the K-wire retractor group and the suture-based retractor group for comparative analyses. Patients with severe liver injury or missing data, or treated with other types of retractors were excluded. Results A total of 317 patients were included in our study and there was no conversion to open surgery. There were no significant differences in patient demographics (age, gender, BMI) and types of bariatric surgery between the two groups. The time taken for placement of retractor was significantly shorter in the K-wire retractor group, in addition to higher operative view score and lesser ALT/AST elevation compared with the suture-based retractor group. Although the K-wire retractor group was less inclined to require additional retraction techniques, patients with BMI ≥ 50 Kg/m2 were associated with higher risk (OR:3.8; 95% CI: 1.2, 12.8) of requiring additional retractors. There were no severe K-wire retractor-related complications observed. Conclusion The trocar-free K-wire liver retractor is safe, simple, and effective as a standard liver retraction method in bariatric surgery. Keywords Left lateral lobe of liver . K-wire retractor . Bariatric surgery . Morbid obesity
Xuejing Zheng, Qing Sang and Liang Wang contributed equally to this work. * Nengwei Zhang [email protected]
Qing Fan [email protected]
* Zhipeng Sun [email protected]
Dexiao Du [email protected]
Xuejing Zheng [email protected]
Guangzhong Xu [email protected]
Qing Sang [email protected]
Dongbo Lian [email protected]
Liang Wang [email protected] Guanyang Chen [email protected] Yifan Guo [email protected]
Bin Zhu [email protected] 1
Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine (Beijing Shijitan Hospital, Capital Medical University), Tieyi Road, Haidian Distinct, Beijing 100038, China
OBES SURG
Introduction Liver retraction is essential to maintain an adequate operative field and workspace in bariatric surgery. Morbidly obese patients with hypertrophic liver often
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