COMPARISON OF LIVER RETRACTOR FOR INTRATOPERATIVE LIVER DAMAGE
Condition: Liver Damage
MeSH terms: Liver Diseases
Study type: Interventional

Summary: 
      The frequency of laparoscopic bariatric surgery is increasing day by day. In these surgeries,
      the liver masses are also found to be significantly larger due to the high Body Mass Index
      scores. It is known that the application of a diet called liver shrinkage protein diet which
      is applied preoperatively is a method that contributes to the comfort of the surgeon during
      surgery by reducing the size of the liver. The large size of the liver narrows the field of
      view of the surgeon in operation and decreases the comfort of surgery. One of the most
      important points that the surgeon must solve during surgery is the exclusion of the left lobe
      of the liver. The most commonly used types of liver retractors today; Nathanson retractor,
      Snowden-Window retractor, Snake retractor, Fan retractor, LIvac retractor and many other
      retractors. Some of these retractors require an additional incision under xiphoid, which may
      lead to an injury risk. The installation of these retractors also increases the operation
      time and requires additional time. Numerous studies have shown that retractors, which are
      used to rule out liver left lobe during surgery, cause liver damage. However, in order to
      reveal His angle in the esophageal-gastric composition, hepatic left lobe exclusion is
      mandatory. Therefore, it is necessary to determine and use the retractor type which causes
      the least damage between the liver retractors. In our study, it was aimed to reveal three
      types of liver retractors in our hospital in different cases and to reveal the type of trocar
      that causes the least amount of liver damage.
    

Detailed description: 
      During laparoscopic upper abdominal surgery, the operative view is usually blocked by the
      left lobe of the liver. An effective liver retraction is important for good vision and safety
      during operation. In this study, 120 patients who are over 18 years old with laparoscopic
      sleeve gastrectomy will be included. 4 groups will be formed and each group will be planned
      to include 30 patients. In group 1, a 5 mm incision was made under xiphoid during the
      operation, and Nathanson retractor was placed and liver left lobe retraction would be
      achieved. In the second group, a snake retractor with a 5 mm incision under the xiphoid will
      be used. In the 3rd group, liver retraction will be provided by using a 5 mm trocar from the
      intersection of the right midclavicular line. In the group, liver retraction through a 5 mm
      trocar entrained from the intersection of the right midclavicular line and a 4 cm superior
      umbilicus will be provided with the aid of laparoscopic grasper without any special tools. In
      these patients, aspartate aminotransferase, alanine aminotransferase and Bilirubin levels
      will be examined on the postoperative 1st, 2nd and 3rd days and the patients will be examined
      with postoperative first day abdominal abdomen magnetic resonance imaging and the liver
      injury will be evaluated by the radiologist. Patients will not know which liver excision
      method is used during surgery. The radiologist who will perform damage assessment on imaging
      will not know which type of liver dislocation is used. Therefore, the study will be planned
      as double blind. The liver excision method will be applied sequentially. Randomization will
      be done in this way.
    

Intervention name(s): liver retraction Nathanson retractor; liver retraction snake retractor; liver retraction fan retractor; liver retraction laparoscopic grasper
Intervention type(s): Procedure; Procedure; Procedure; Procedure
Intervention description(s): liver retractor will be used for the retraction of left lobe of liver; liver retractor will be used for the retraction of left lobe of liver; liver retractor will be used for the retraction of left lobe of liver; laparoscopic grasper without any special tools
Other intervention name(s): nathanson retractor
Intervention MeSH terms: Liver Extracts
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: In this study, 120 patients who are over 18 years old with laparoscopic sleeve gastrectomy will be included. 4 groups will be formed and each group will be planned to include 30 patients. In group 1, a 5 mm incision was made under xiphoid during the operation, and Nathanson retractor was placed and liver left lobe retraction would be achieved. In the second group, a snake retractor with a 5 mm incision under the xiphoid will be used. In the 3rd group, liver retraction will be provided by using a 5 mm trocar from the intersection of the right midclavicular line. In the control group, liver retraction through a 5 mm trocar entrained from the intersection of the right midclavicular line and a 4 cm superior umbilicus will be provided with the aid of laparoscopic grasper without any special tools.
Masking: None (Open Label)
Primary purpose: Prevention