Advancements in liver retraction techniques for laparoscopic gastrectomy

Table 1 Summary of published evidence describing the hepatic inversion technique for liver retraction during minimal invasive surgery

Ref.	Technique details	Operations	No of patients	Comments
Lin et al[18]	Modified hepatic left lateral lobe inversion as per Harada	Laparoscopic proximal gastrectomy	13 patients	No reports of hepatic injury, congestion, or ischaemia
Nakamura et al[19]	Suture of the round ligament to the peritoneum. The round, falciform, left triangular, and coronary ligaments were divided. The hepatogastric ligament was also divided to the depth of the ligamentum venosum	Laparoscopic proximal gastrectomy	81 patients (40 patients undergoing left lateral lobe inversion)	No reports of hepatic injury, congestion, or ischaemia
Harada et al[20]	2-0 straight needle to the peritoneum of the round ligament and pulling it to the outside of the abdominal cavity. The falciform, left triangular, and coronary ligaments were dissected	Laparoscopic total and proximal gastrectomy	24 patients	One intra-operative liver injury and Nathanson retractor insertion required in three patients
Yoshikawa et al[21]	Mobilisation through dissection of falciform, coronary, triangular, and pars flaccida of the hepatogastric ligament. A hooked organ retractor was then used to grasp the pars condense for inversion	Laparoscopic total gastrectomy	32 patients (12 patients with mobilisation)	No reports of hepatic injury, congestion, or ischaemia