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A Simple Method of Intracorporeal “W-shaped” Liver Retraction Technique for Minimally Invasive Gastric Cancer Surgery

Wang, Chih-Jung, MD*; Chao, Ying-Jui, MD*,†; Sy, Edgar D., MD*; Shan, Yan-Shen, MD, PhD*,†

Surgical Laparoscopy Endoscopy & Percutaneous Techniques: June 2019 - Volume 29 - Issue 3 - p e24–e28
doi: 10.1097/SLE.0000000000000648
Online Articles: Technical Reports

Background: Minimally invasive gastric cancer surgery requires an extended liver retraction in order to provide optimal operative view, working space for lymph node dissection, and esophageojejunal reconstruction. Ideally, it should avoid reposition of the retractor, additional skin incision or puncture, and liver parenchyma injury. Herein, we introduced an intracorporeal W-shaped liver retraction technique (W-LRT) for minimally invasive gastric cancer surgery without an additional incision or abodminal puncture.

Methods: Between October 2013 and October 2016, the W-LRT was applied in 80 patients undergoing minimally invasive gastric cancer surgery. The W-LRT was performed using one 75 cm 3-0 monocryl suture with its end fixed to one hemoclip. The perioperative outcome was recorded.

Results: The W-LRT was applied in 80 gastric cancer patients using either laparoscopic approach (N=69) or robotic approach (N=11). The mean age was 62.7±14 years and the mean body mass index (BMI) was 24.1±3.6 kg/m2. The time required for W-LRT was 5.6±5.2 minutes in laparoscopic approach and 6.2±4.7 minutes in robotic approach. This technique was successfully applied in all procedures and no other technique or additional instrument was required. Major complications developed in 7 patients (8.8%), classified as greater than Clavien-Dindo classification II; however, there was neither any intraoperative nor postoperative major complication related to W-LRT. The length of hospital stay was 9.1±4.4 days.

Conclusions: In laparoscopic or robotic gastric cancer surgery, the W-LRT can provide excellent operative view during lymph node dissection and reconstruction of esophagojejunostomy and eliminate an additional skin incision or abdominal puncture.

*Department of Surgery, National Cheng Kung University Hospital

Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan

The author declares no conflicts of interest.

Reprints: Ying-Jui Chao, MD, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan, 138, Sheng-Li Road, Tainan 70428, Taiwan (e-mail:

Received November 1, 2018

Accepted January 7, 2019

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