Advertisement

Magnetic Liver Retraction: an Incision-Less Approach for Less Invasive Bariatric Surgery

  • Matthew Davis
  • Gerardo Davalos
  • Camila Ortega
  • Sugong Chen
  • Scott Schimpke
  • Kunoor Jain-Spangler
  • Jin Yoo
  • Keri Seymour
  • Ranjan Sudan
  • Dana Portenier
  • Alfredo D. GuerronEmail author
New Concept

Abstract

Background

In bariatric surgery, retraction of the liver is essential to ensure appropriate visualization of the surgical field. Many devices are currently employed for this purpose. Generally, these devices require constant use of a port, or an additional incision. Magnetic technology provides a novel solution, by allowing liver retraction during bariatric procedures that do not require a dedicated port nor an extra incision.

Methods

Retrospective review of consecutive patients who underwent magnetic-assisted liver retraction during primary or revisional laparoscopic bariatric surgery at the Duke Center for Metabolic and Weight Loss Surgery between October 2016 and August 2017.

Results

The 73 cases were comprised of 29 primary sleeve gastrectomies, 24 gastric bypasses, 10 duodenal switches, 3 gastric band removals, and 7 revisions. All cases were completed laparoscopically. Mean pre-operative BMI was 43.6 kg/m2 (range 18.3–67.7 kg/m2). Mean operative times for primary cases were similar to published averages. Two patients experienced minor 30-day morbidities, neither of which were attributed to the device and did not require further interventions. There were no 30-day mortalities. Surgeons described subjective overall surgical exposure as adequate and device utilization as technically simple even for the large livers.

Conclusions

Magnetic-assisted retraction is a novel approach that allows a safe, reproducible, incision-less technique for unconstrained, port-less intra-abdominal mobilization. The device successfully permitted optimal liver retraction during laparoscopic bariatric surgery, enhancing surgical exposure while decreasing the number of abdominal incisions.

Keywords

Bariatric surgery Liver retraction Magnetic-assisted surgery Incision-less Laparoscopic 

Notes

Compliance with Ethical Standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

Gerardo Davalos, Camila Ortega, Scott Schimpke, Sugong Chen, Kunoor Jain-Spangler, and Ranjan Sudan have no conflicts of interest. Matthew Davis has no conflicts of interest relevant to this publication, but has received a consultation fee from Medtronic. Jin Yoo has no conflicts of interest relevant to this publication, but is a consultant and speaker for Novadaq, Stryker, and Gore, and is a consultant for Teleflex. Keri Seymour has no conflicts of interest relevant to this publication, but is a speaker for Gore and Medtronic, and is a consultant for Teleflex. Dana Portenier has received an education grant from Levita Magnetics, has received an education grant from Gore, is a consultant, has received a research grant from Medtronic, and is a consultant for Intuitive. Alfredo D Guerron is a consultant for Levita Magnetics and a speaker for Gore and Medtronic.

References

  1. 1.
    Vargas-Palacios A, Hulme C, Veale T, et al. Systematic review of retraction devices for laparoscopic surgery. Surg Innov. 2016;23(1):90–101.CrossRefGoogle Scholar
  2. 2.
    Benzing C, Weiss H, Krenzien F, et al. Intra-abdominal trocar-free vacuum liver retractor for upper-gastrointestinal surgery. Surg Innov. 2017;24(2):186–91.CrossRefGoogle Scholar
  3. 3.
    Madnani MA, Patel TJ, Gupta AK, et al. Novel trocarless, scarless technique for left lobe liver retraction in laparoscopic upper gastrointestinal surgeries: simple, cost-effective and with better cosmesis. Indian J Surg. 2015;77(Suppl 3):1441–3.CrossRefGoogle Scholar
  4. 4.
    Rivas H, Robles I, Riquelme F, et al. Magnetic surgery: results from first prospective clinical trial in 50 patients. Ann Surg. 2018;267(1):88–93.CrossRefGoogle Scholar
  5. 5.
    Haskins IN, Strong AT, Allemang MT, et al. Magnetic surgery: first U.S. experience with a novel device. Surg Endosc. 2018;32(2):895–9.CrossRefGoogle Scholar
  6. 6.
    Guerron A, Ortega C, Park C, et al. Magnetic robot-assisted single-incision cholecystectomy. CRSLS. 2018;00073:e2017.Google Scholar
  7. 7.
    Zeltser IS, Bergs R, Fernandez R, et al. Single trocar laparoscopic nephrectomy using magnetic anchoring and guidance system in the porcine model. J Urol. 2007;178(1):288–91.CrossRefGoogle Scholar
  8. 8.
    Cadeddu J, Fernandez R, Desai M, et al. Novel magnetically guided intra-abdominal camera to facilitate laparoendoscopic single-site surgery: initial human experience. Surg Endosc. 2009;23(8):1894–9.CrossRefGoogle Scholar
  9. 9.
    Park S, Bergs RA, Eberhart R, et al. Trocar-less instrumentation for laparoscopy: magnetic positioning of intra-abdominal camera and retractor. Ann Surg. 2007;245(3):379–84.CrossRefGoogle Scholar
  10. 10.
    Best SL, Bergs R, Scott DJ, et al. Solo surgeon laparo-endoscopic single site nephrectomy facilitated by new generation magnetically anchored and guided systems camera. J Endourol. 2012;26(3):214–8.CrossRefGoogle Scholar
  11. 11.
    Uematsu D, Akiyama G, Magishi A, et al. Single-access laparoscopic left and right hemicolectomy combined with extracorporeal magnetic retraction. Dis Colon Rectum. 2010;53(6):944–8.CrossRefGoogle Scholar
  12. 12.
    Dominguez G, Durand L, De Rosa J, et al. Retraction and triangulation with neodymium magnetic forceps for single-port laparoscopic cholecystectomy. Surg Endosc. 2009;23(7):1660–6.CrossRefGoogle Scholar
  13. 13.
    Garcia-Roig ML, Travers C, McCracken C, et al. Surgical scar location preference for pediatric kidney and pelvic surgery: a crowdsourced survey. J Urol. 2017;197(3 Pt 2):911–9.CrossRefGoogle Scholar
  14. 14.
    Arora A, Swords C, Garas G, et al. The perception of scar cosmesis following thyroid and parathyroid surgery: a prospective cohort study. Int J Surg. 2016;25:38–43.CrossRefGoogle Scholar
  15. 15.
    de Lissovoy G, Fraeman K, Hutchins V, et al. Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control. 2009;37(5):387–97.CrossRefGoogle Scholar
  16. 16.
    Murray BW, Cipher DJ, Pham T, et al. The impact of surgical site infection on the development of incisional hernia and small bowel obstruction in colorectal surgery. Am J Surg. 2011;202(5):558–60.CrossRefGoogle Scholar
  17. 17.
    Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg. 2008;248(2):189–98.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Matthew Davis
    • 1
  • Gerardo Davalos
    • 1
  • Camila Ortega
    • 1
  • Sugong Chen
    • 1
  • Scott Schimpke
    • 1
  • Kunoor Jain-Spangler
    • 1
  • Jin Yoo
    • 1
  • Keri Seymour
    • 1
  • Ranjan Sudan
    • 1
  • Dana Portenier
    • 1
  • Alfredo D. Guerron
    • 1
    Email author
  1. 1.Department of Surgery, Division of Weight Loss and Metabolic SurgeryDuke University Medical CenterDurhamUSA

Personalised recommendations