Water-Mediated On-Demand Detachable Solid-State Adhesive of Porous Hydroxyapatite for Internal Organ Retractions

Novel adhesives for biological tissues offer an advanced surgical approach. Here, the authors report the development and application of solid-state adhesives consisting of porous hydroxyapatite (HAp) biocompatible ceramics as novel internal organ retractors. The operational principles of the porous solid-state adhesives are experimentally established in terms of water migration from biological soft tissues into the pores of the adhesives, and their performance is evaluated on several soft tissues with different hydration states. As an example of practical medical utility, HAp adhesive devices demonstrate the holding ability of porcine livers and on-demand detachability in vivo, showing great potential as internal organ retractors in laparoscopic surgery.

Magnetic Liver Retraction Decreases Postoperative Pain and Length of Stay in Bariatric Surgery Compared to Nathanson Device

Objective: Retrospective case-matched comparison of magnetic liver retraction to a bedrail-mounted liver retractor in bariatric surgery specifically targeting short-term postoperative outcomes, including pain and resource utilization. Background: Retraction of the liver is essential to ensure appropriate visualization of the hiatus in bariatric surgery. Externally mounted retractors require a dedicated port or an additional incision. Magnetic devices provide effective liver retraction without the need of an incision. Methods: The sample consisted of primary and revisional bariatric surgery patients, including Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and biliopancreatic diversion with duodenal switch (BPD-DS) operations. Propensity score analysis was used to match patients with magnetic retraction to patients with a bedrail-mounted retractor with a 1:2 ratio using preoperative characteristics. Baseline characteristics and postprocedure outcomes were compared using two-sample t-tests or Wilcoxon rank sum tests and chi-square or Fisher's exact test as appropriate. Results: One hundred patients met inclusion criteria for the use of magnetic liver retraction (45 RYGB, 35 SG, 20 BPD-DS) with 196 suitable matched external retractor patients identified. Patients were matched and comparable for all preoperative characteristics except for transversus abdominus plane block (27% versus 47%). Patients in the magnet cohort had significantly decreased mean 12-hour postoperative pain scores (2.9 versus 4.2, P = .004) and decreased hospital length of stay (LOS) (1.5 versus 1.9 days, P = .005) while operating room supply were higher in the magnet cohort ($4600 versus $4213, P = .0001). Conclusions: Magnetic liver retraction in bariatric surgery is associated with decreased postoperative pain scores, decreased hospital LOS, and increased operating supply costs.

Low-Cost Incisionless Liver Retraction for Laparoscopic Sleeve Gastrectomy: A Prospective Controlled Trial

Background: Laparoscopic bariatric surgery has been performed safely since 1991. In a persistent search for fewer and smaller scars, single port, needlescopic surgery, and other approaches have been implemented. Our goal was to analyze the safety and feasibility of using incisionless autostatic liver retraction for sleeve gastrectomy. Materials and Methods: Candidates for sleeve gastrectomy were selected, excluding those <18 and having had prior upper left quadrant surgery. Patients were randomized 1:1 to either a standard five-port technique with a fan-type liver retractor (Group A); or a four-port technique with the liver retracted using a polypropylene 1 suture passed through the right crura and retrieved at the epigastrium employing a fascial closure needle (Group B). All surgeries were performed by the same surgeon. The primary endpoint was surgery duration. Secondary outcomes were quality of surgical-field visualization, complications inherent to liver retraction, and postoperative morbidity. Results: One hundred patients were recruited (n = 50/group). The groups (both 90% females) were demographically and anthropomorphically comparable. Surgery duration was 30.4 ± 4.6 and 29.6 ± 4.7 minutes for Groups A and B, respectively (P = .41). Visualization was considered very good in 80% versus 82%, good in 16% versus 12%, and poor in 4% versus 6% (P = NS). Two patients from each group (4%) had self-limited minor bleeding from the liver attributed to the retraction technique. No 30-day morbidity was observed. Conclusions: Liver retraction using a polypropylene suture was both effective and inexpensive. Visualization and the duration of surgery were comparable to a standard liver retractor. This low-cost alternative may diminish the need for expensive instruments and reduce the number of scars without jeopardizing the safety and quality of sleeve gastrectomy.

An atraumatic retractor for interdisciplinary use in conventional laparoscopy and robotic surgery

BACKGROUND

The removal of obstacles from the surgical field is a crucial aspect of any procedure in gynecological, urological or visceral laparoscopic surgery. Reliable instruments and skilled assistance are essential for the smooth execution of procedures. Blunt forceps are commonly used to keep tissue away from the operating field. The range of existing instruments has been enhanced by the introduction of laparoscopic retractors. However, no laparoscopic retractor can be used without causing tissue damage.

MATERIAL AND METHODS

We describe the ALKATOUT retractor, an innovative laparoscopic retractor designed for atraumatic assistance in any laparoscopic procedure including robotic surgery. The advantages of this laparoscopic instrument were evaluated in a single-center study.

RESULTS

The retractor has been used successfully in a variety of gynecological procedures and tested in laparoscopic procedures on human body donors.

CONCLUSIONS

The results of a single-center questionnaire completed by 25 operating room staff (surgical nurses, residents, and specialists) confirm the advantages of the ALKATOUT retractor.