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Laparoscopic Cholecystectomy with the FreeHold Duo Retractor - Case Study
Introduction
The first laparoscopic cholecystectomy was reported in 1987, introducing an era of minimally invasive surgery for this common procedure. Advantages of the laparoscopic approach include reduced postoperative pain and recovery time and improved cosmesis.17 Since its introduction, the laparoscopic approach has been modified to reduce even further the number of incisions and trocars needed, while maintaining operative efficiency and good outcomes.34 This report describes the use of a totally intracorporeal retractor (FreeHold Duo™) that eliminates the need for mechanical retractors, additional incisions, and an assistant during laparoscopic cholecystectomy, even in challenging cases.
Minimizing Invasiveness
Cholecystectomy requires upward retraction of the liver lobe to visualize and access the gallbladder. The conventional approach to retraction during laparoscopic cholecystectomy involves the insertion of an atraumatic grasper that is held by an assistant and requires an additional incision and/or port, increasing risks for wound complications.
Conversely, suture-based methods of organ retraction are associated with fewer complications compared to mechanical retractors/*6 And studies of approaches using fewer incisions and ports describe similar operative time, incidence of complications, and length of stay; improved cosmetic outcomes and body image; and less postoperative pain, compared to procedures using more ports.7-9
An ideal method for retraction during laparoscopic cholecystectomy would lift the gallbladder and liver in a non-traumatic manner, providing adequate space for visualization and dissection for as long as required and without the need for additional ports or assistance.
FreeHold Hands-Free Intracorporeal Retractors
FreeHold Duo™ is an intracorporeal retractor that can be used in minimally invasive procedures. This simple retractor is fully adjustable, hands-free, completely intracorporeal, and enables full surgeon autonomy.
FreeHold Duo™ consists of two hook assembly (one adjustable, one fixed), connected by a length of suture that can be adjusted to provide appropriate tension. The device can be inserted through an existing 5mm trocar, eliminating the need for an additional incision, trocar, or robotic instrument.
Using the adjustable hook, the surgeon controls the positioning and tension of the retractor. Sliding the release ring on the adjustable hook towards the hook with a grasper allows the suture to slide freely through the housing for easy adjustments. Once positioned, the surgeon has full use of both hands to perform the procedure, obviating the need for coordination with an assistant The retractor can also be easily repositioned and the amount of tension adjusted as necessary during the procedure.