Abstract
Purpose: We examined that the manipulations of liver retractors in laparoscopy-assisted gastrectomy (LAG), and the influence of postoperative liver function on liver retraction in LAG. Patients and Methods: We investigated one hundred and fourteen patients undergoing LAG in our institution: P method group (the technique using a Penrose drain to suspend the liver; n=13), S method group (snake retractor connected to the Octopus retractor holder; n=19), and N method group (Nathanson liver retractor connected to the Octopus retractor holder; n=82). To investigate the difference for three liver retrarctions, we measured the time required the liver retraction, and the alanine aminotransferase (ALT) levels preoperatively, on postoperative day (POD) 1 and on POD 7. Results: The time required the liver retraction was 14.1 min (P method group), 3.8 min (S method group), and 2 min (N method group). On N method group we needed the shortest time to retract liver with significant (p<0.0001). On all groups ALT level on POD1 increased than preoperative ALT level significantly, and ALT level on POD7 decreased than ALT level on POD1 significantly. Examining the proportion of ALT level on POD1 to preoperative ALT level, the proportion of N method group was significantly lower than P method groups (p=0.0071). Abnormal elevation of ALT (>200 IU/l) was observed in 4 patients of S method group (21.1%), and 7 patients of S method group (8.5%). On the other hand, no patient in P method group showed an abnormal elevation of ALT. Conclusions: It is possible for the Nathanson liver retractor to retract liver quickly, but we give special attention to liver dysfunction postoperatively.
