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. 2024 Sep;76(5):2059-2063.
doi: 10.1007/s13304-024-01928-x. Epub 2024 Jul 5.

Instrumentless liver suspension for liver retraction in robotic pancreatoduodenectomy

Michael Ginesini  1 , Virginia Viti  1 , Allegra Ripolli  1 , Ugo Boggi  2
Affiliations

Instrumentless liver suspension for liver retraction in robotic pancreatoduodenectomy

Michael Ginesini et al. Updates Surg. 2024 Sep.

Abstract

The popularity of robotic pancreatoduodenectomy (RPD) is increasing, yet it remains a complex procedure. Outcomes are influenced by various factors, including patient-specific variables, disease characteristics, and surgical technique. Numerous and intricate details contribute to the technical success of RPD. In this study, our focus is on achieving effective and "gentle" liver retraction. The use of liver retractors has been associated with the risk of retractor-related liver injury (RRLI), which can have serious consequences. Here, we introduce a refined technique for instrumentless liver retraction in RPD, developed progressively through a series of over 300 procedures. The core concept of this technique involves suspending the liver to the diaphragmatic dome. This is accomplished by securing the round ligament to the anterior abdominal wall using transparietal sutures and attaching the fundus of the gallbladder and the anterior margin of liver segment number 3 to the diaphragm. Our consecutive series of over 300 RPDs demonstrates the feasibility and safety of this approach, with no clinically relevant RRLI observed. Instrumentless liver retraction offers a valuable refinement in RPD, streamlining the procedure while reducing potential complications associated with dedicated retractors.

Keywords: Liver injury; Liver retraction; Minimally invasive pancreatoduodenectomy; Postoperative complications; Retractor-related liver injury; Robotic pancreatoduodenectomy.

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