A Triangle Method: Simple Suture Retraction for the Left Lobe of the Liver During Laparoscopic Gastric Surgery

Background: Efficient retraction of the left lobe of the liver is mandatory for laparoscopic gastric surgery because of the lesser curvature of the stomach, the gastroesophageal junction, and the gastrohepatic ligaments that are covered by the left lobe. We attempted to introduce our simple and safe method for lifting up the liver by suturing the pars condensa and the right diaphragmatic crus at the same time. Study Design: Between March 2011 and February 2012, 85 patients (52 men and 33 women) underwent laparoscopic gastrectomy for gastric cancer using our liver retraction method. Our procedure included combined suturing of the pars condensa and the right crus and retrieval of the thread on both sides of the xiphoid process. The end result is a triangle-shaped sling with the left lobe sitting on it. Results: There were 65 totally laparoscopic distal gastrectomy, 18 totally laparoscopic total gastrectomy, and two laparoscopy-assisted distal gastrectomy cases. The mean patient age was 58.7 years (range, 28-82 years), and average body mass index was 24.5 kg/m(2) (range, 16.7-32.0 kg/m(2)). In all cases, we acquired adequate exposure of the surgical field without the help of another instrument, and there were no procedure-related complications such as hepatic laceration, bleeding, or bile leakage. Conclusions: Our liver retraction method is a simple, safe, and effective procedure for laparoscopy-assisted gastrectomy as well as totally laparoscopic gastrectomy. It can be also useful in other types of laparoscopic gastric surgery.