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The following is a summary of “A case-series study of hepatic left lateral segment inversion for surgical field exposure in laparoscopic gastrectomy,” published in the October 2024 issue of Surgery by Tian et al.       

Retraction of the hepatic left lateral segment (HLLS) is essential for surgical exposure during laparoscopic gastrectomy and systematic lymphadenectomy.  

Researchers conducted a prospective study to evaluate the feasibility, safety, and effectiveness of HLLS inversion during laparoscopic gastrectomy.  

They reviewed the intraoperative and short-term postoperative outcomes of 42 patients who underwent laparoscopic total gastrectomy (LTG) and proximal gastrectomy (LPG) using HLLS inversion (September, 2023 to January, 2024).  

The results showed that 42 patients successfully underwent HLLS inversion, with an average inversion time of 13.9 minutes. Optimal surgical field exposure was achieved in all patients, with no intraoperative complications except for 1 case of mild intraoperative hepatic hemorrhage requiring electrocoagulation. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were elevated on postoperative day 1 (POD1) but returned to baseline by postoperative day 7 (POD7). No Clavien-Dindo II grade or higher complications occurred, and gallbladder contractile function was intact or slightly impaired in 5 patients with a preserved hepatic branch of the vagus nerve.  

The study concluded that HLLS inversion was a feasible and safe technique for enhancing surgical visibility during LPG and LTG, preserving the hepatic branch of the vagus nerve function.  

Source: bmcsurg.biomedcentral.com/articles/10.1186/s12893-024-02635-5