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Novel use of the Nathanson liver retractor to prevent postoperative transient liver dysfunction during laparoscopic gastrectomy

INTRODUCTION: The Nathanson liver retractor (N) has been known to cause postoperative transient liver dysfunction (POTLD) in laparoscopic gastrectomy (LG). To reduce the incidence of POTLD, specifically we added to the retractor the use of a disk (N + D) to reduce the localized pressure, and further...

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Autores principales: Hiramatsu, Kazuhiro, Aoba, Taro, Kamiya, Tadahiro, Mohri, Koichi, Kato, Takehito
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley & Sons Australia, Ltd 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7379723/
https://www.ncbi.nlm.nih.gov/pubmed/31389200
http://dx.doi.org/10.1111/ases.12735
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author Hiramatsu, Kazuhiro
Aoba, Taro
Kamiya, Tadahiro
Mohri, Koichi
Kato, Takehito
author_facet Hiramatsu, Kazuhiro
Aoba, Taro
Kamiya, Tadahiro
Mohri, Koichi
Kato, Takehito
author_sort Hiramatsu, Kazuhiro
collection PubMed
description INTRODUCTION: The Nathanson liver retractor (N) has been known to cause postoperative transient liver dysfunction (POTLD) in laparoscopic gastrectomy (LG). To reduce the incidence of POTLD, specifically we added to the retractor the use of a disk (N + D) to reduce the localized pressure, and furthermore repositioned the retractor every 30 minutes (N + D TM) to reduce the liver retraction time. Before and after introducing this retractor, we assessed four consecutive retraction procedures. These included the following disk suspension methods (D), N, N + D, and N + D TM. METHODS: We retrospectively enrolled 85 patients who underwent an LG. In the D, N, N + D, and N + D TM groups, we evaluated the postoperative serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) values. RESULTS: For the D and N groups, the AST value significantly increased from the immediate post‐operation time point (IPOT) to the third postoperative day (POD3). Additionally, the ALT value increased from IPOT to POD7. In the N + D group, the only decrease was in the ALT value at IPOT compared to the N group. The N + D TM group decreased in both the AST value from IPOT to POD3 and in the ALT value from IPOT to POD7, compared to the N group. CONCLUSIONS: Our findings demonstrate the importance of reducing both the localized pressure and liver retraction time when using the Nathanson retractor to prevent POTLD during an LG. To make this possible, we successfully introduced the use of both a disk and the repositioning of the retractor at 30 minute intervals.
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spelling pubmed-73797232020-07-27 Novel use of the Nathanson liver retractor to prevent postoperative transient liver dysfunction during laparoscopic gastrectomy Hiramatsu, Kazuhiro Aoba, Taro Kamiya, Tadahiro Mohri, Koichi Kato, Takehito Asian J Endosc Surg Original Articles INTRODUCTION: The Nathanson liver retractor (N) has been known to cause postoperative transient liver dysfunction (POTLD) in laparoscopic gastrectomy (LG). To reduce the incidence of POTLD, specifically we added to the retractor the use of a disk (N + D) to reduce the localized pressure, and furthermore repositioned the retractor every 30 minutes (N + D TM) to reduce the liver retraction time. Before and after introducing this retractor, we assessed four consecutive retraction procedures. These included the following disk suspension methods (D), N, N + D, and N + D TM. METHODS: We retrospectively enrolled 85 patients who underwent an LG. In the D, N, N + D, and N + D TM groups, we evaluated the postoperative serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) values. RESULTS: For the D and N groups, the AST value significantly increased from the immediate post‐operation time point (IPOT) to the third postoperative day (POD3). Additionally, the ALT value increased from IPOT to POD7. In the N + D group, the only decrease was in the ALT value at IPOT compared to the N group. The N + D TM group decreased in both the AST value from IPOT to POD3 and in the ALT value from IPOT to POD7, compared to the N group. CONCLUSIONS: Our findings demonstrate the importance of reducing both the localized pressure and liver retraction time when using the Nathanson retractor to prevent POTLD during an LG. To make this possible, we successfully introduced the use of both a disk and the repositioning of the retractor at 30 minute intervals. John Wiley & Sons Australia, Ltd 2019-08-07 2020-07 /pmc/articles/PMC7379723/ /pubmed/31389200 http://dx.doi.org/10.1111/ases.12735 Text en © 2019 The Authors. Asian Journal of Endoscopic Surgery published by Asia Endosurgery Task Force and Japan Society of Endoscopic Surgery and John Wiley & Sons Australia, Ltd. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Articles
Hiramatsu, Kazuhiro
Aoba, Taro
Kamiya, Tadahiro
Mohri, Koichi
Kato, Takehito
Novel use of the Nathanson liver retractor to prevent postoperative transient liver dysfunction during laparoscopic gastrectomy
title Novel use of the Nathanson liver retractor to prevent postoperative transient liver dysfunction during laparoscopic gastrectomy
title_full Novel use of the Nathanson liver retractor to prevent postoperative transient liver dysfunction during laparoscopic gastrectomy
title_fullStr Novel use of the Nathanson liver retractor to prevent postoperative transient liver dysfunction during laparoscopic gastrectomy
title_full_unstemmed Novel use of the Nathanson liver retractor to prevent postoperative transient liver dysfunction during laparoscopic gastrectomy
title_short Novel use of the Nathanson liver retractor to prevent postoperative transient liver dysfunction during laparoscopic gastrectomy
title_sort novel use of the nathanson liver retractor to prevent postoperative transient liver dysfunction during laparoscopic gastrectomy
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7379723/
https://www.ncbi.nlm.nih.gov/pubmed/31389200
http://dx.doi.org/10.1111/ases.12735
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