PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of annrcseLink to Publisher's site
 
Ann R Coll Surg Engl. 2009 September; 91(6): 515–517.
PMCID: PMC2966209
Technical Notes and Tips
Bruce Campbell, Section Editor

Fat Retraction in Laparoscopic Surgery

BACKGROUND

In laparoscopic surgery, views of the left upper quadrant may be impaired by omentum (Fig. 1). Access to the angle of His, which is crucial for both laparoscopic fundoplication and laparoscopic gastric banding, is difficult in the obese. We describe a technique to retract fat during laparoscopic procedures.

Figure 1
Omentum obscuring access to the angle of His.

TECHNIQUE

Using the most lateral port in the left upper quadrant, a 2-O nylon suture is used to pick up several bites of the greater omentum lying between the spleen and greater curve of the stomach (Fig. 2). The suture is then removed through the 11-mm port so that both ends are extracorporeal. The port is removed and replaced alongside the suture. Under direct vision, the suture is put under tension to retract the greater omental fat and clipped externally (Fig. 3). Access to the angle of His is thereby improved (Figs 4 and and55).

Figure 2
Several bites of omentum are taken in the stitch.
Figure 3
The suture is clipped externally to maintain traction.
Figure 4
View prior to fat retraction.
Figure 5
View subsequent to fat retraction.

DISCUSSION

The senior author (MR) has used this method successfully for 15 years with no serious intra- or postoperative complications. One cautionary note is to ensure retraction is undertaken under direct vision to avoid tearing any adhesions to the spleen. The technique is a safe and simple method of fat retraction that can significantly improve surgical access to the angle of His during complex laparoscopic procedures.


Articles from Annals of The Royal College of Surgeons of England are provided here courtesy of The Royal College of Surgeons of England