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A simple and inexpensive technique of upper abdominal wall retraction in pediatric liver surgery and transplantation
Author(s) -
Wang ShihHo,
Concejero Allan M,
Chen ChaoLong,
Wang ChihChi,
Lin ChihChe,
Liu YeuhWei,
Yang ChinHsiang,
Yong CheeChien
Publication year - 2008
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/j.1399-3046.2007.00818.x
Subject(s) - medicine , retractor , surgery , operating table , pediatric surgeon , transplantation , pediatric surgery , liver transplantation , abdominal wall , complication , general surgery
In majority of centers, pediatric liver surgery and transplantation involves a team of four at any given time: the surgeon, the first and second assistants, and the instrument nurse. This creates considerable crowding around both operative field and operating table. Mechanical devices have been occasionally employed to solve this problem, but most table‐mounted devices are designed for adult patients. Based on our experience with pediatric living donor liver transplantation, we developed a simple, safe, and inexpensive method of upper abdominal wall retraction to facilitate surgical exposure and avoid over‐crowding in the sterile field. The key points of this technique are the use of the Mercedes incision for liver transplantation or right subcostal incision with upper abdominal midline extension for hepatic resection and an adult‐designed Kent retractor. A pediatric‐designed Kent retractor is expensive, unnecessary, and may even cause complications as rib fractures and nerve paralysis. We used this technique in 142 consecutive pediatric living donor liver transplants and 16 major hepatectomies in children without any complication resulting from the exposure. The presented technique is simple, safe, reliable, and inexpensive. It can be used in pediatric liver surgery, as well as general pediatric upper abdominal operations.