Systematic review of retraction devices for laparoscopic surgery

Objective: To explore the advantages and disadvantages of different retraction devices used for laparoscopic surgery. The main focus was on its impact on operation time, length of stay, use of staff, complications or negative outcomes (such as pain, liver functioning or damage, blood loss), operative difficulty and conversion rates to open surgery. Methods: A systematic review of the literature was performed using MEDLINE, Embase, the Cochrane library, and ongoing trials sources. The search strategy focused on laparoscopic studies that had as primary objective the test of a retraction device. Studies were included if they met the predefined set of inclusion and exclusion criteria. Data extraction of included papers was performed and the data was analysed. Results: Out of 1360 initially retrieved, 12 articles were selected for data extraction and analysis. A total of 13 instruments (11 devices and 2 techniques) were described in those articles. Among the devices found are the Nathanson’s retractor device, the Liver suspension tape or (TST), a Silicone disk, the Endoloop, the R-Scope, two magnetic retractors, the Endograb, the VaroLift a Laparoscope holder and a Retraction sponge. While the V-List and Trans-abdominal stay sutures techniques were used as comparators in some studies. None of the instruments reported a permanent damage in the liver function nor a relevant complication or adverse event related to its usage. No conversion rates to open surgery were necessary. All articles reported that the tested instruments might spare the use of a surgeon assistant during the procedure. It was not possible to determine the impact on either the length of stay, or the operation time, although the Nathanson’s instrument had the quickest set up time. Conclusions: This systematic review of the literature on laparoscopic retrieving devices provided an insight into the different instruments available for retraction during laparoscopic surgery. Although each analysed device has its advantages and disadvantages, in general terms their use during laparoscopic intervention facilitates the retraction procedure, provides a good field of view, causes no relevant complications, and reduces the use of staff or allows them to assist in different activities, while making conversions to open surgery unnecessary.