The Hepatic Left Lateral Segment Inverting Method Offering a Wider Operative Field of View During Laparoscopic Proximal
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MULTIMEDIA ARTICLE
The Hepatic Left Lateral Segment Inverting Method Offering a Wider Operative Field of View During Laparoscopic Proximal Gastrectomy Kenichi Nakamura, MD, PhD 1 & Koichi Suda, MD, PhD, FACS 1 & Susumu Shibasaki, MD, PhD, FACS 1 & Masaya Nakauchi, MD, PhD, FACS 1 & Kenji Kikuchi, MD, PhD 1 & Kazuki Inaba, MD, PhD, FACS 1 & Ichiro Uyama, MD, PhD, FACS 1 Received: 20 February 2020 / Accepted: 13 May 2020 # 2020 The Society for Surgery of the Alimentary Tract
Abstract Background In laparoscopic proximal gastrectomy, the hepatic left lateral segment often obstructs the operative field of view, especially around the esophageal hiatus. Therefore, a safe retraction method is needed. The present study aimed to determine the effectiveness of inverting the hepatic left lateral segment in laparoscopic proximal gastrectomy. Methods This was a retrospective review of 81 consecutive patients who underwent laparoscopic proximal gastrectomy. Patients were divided into two groups, i.e., the Nathanson liver retractor group (n = 41) and hepatic left lateral segment inverting group (n = 40). The unedited video recordings of the procedures and the patients’ medical records were reviewed and compared. Results The hepatic left lateral segment inverting method provided a more satisfactory view of the operative fields and a wider working space around the esophageal hiatus than the Nathanson liver retractor. No intraoperative hepatic congestion and significantly improved postoperative liver enzyme elevations were observed with hepatic left lateral segment inverting method compared with the Nathanson liver retractor method. Conclusions In laparoscopic proximal gastrectomy, the hepatic left lateral segment inverting method appears to provide improvements in both the operative field of view and liver protection compared with the Nathanson liver retractor method. Keywords Stomach neoplasms . Gastrectomy . Laparoscopy . Intraoperative complications . Postoperative complications
Introduction Proximal gastrectomy has been increasingly performed because of a marked increase in the global incidence of esophagogastric junction carcinoma [1]. During laparoscopic proximal gastrectomy (LPG), the hepatic left lateral segment (HLLS) often obstructs the operative field of view around the esophageal hiatus, especially when mediastinal manipulation is required via that hiatus. We have therefore traditionally used a Nathanson liver retractor (NLR) to displace the HLLS, but this method Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11605-020-04655-x) contains supplementary material, which is available to authorized users. * Koichi Suda, MD, PhD, FACS [email protected] 1
Department of Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192, Japan
sometimes causes hepatic blood stasis through compression, which can induce postoperative elevations in liver enzyme levels [2]. Moreover, it can fail to exclude the HLLS completely from the opera
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