Retraction (or suspension) is a fundamental requirement for all surgical procedures and is more challenging in minimally invasive procedures. Minimally invasive surgery, including laparoscopic and robotic procedures, lacks techniques and tools for optimal tissue and organ retraction. In these procedures, visualization is often suboptimal and deployment of retractors commonly requires the use of an extra port and/or an assistant to hold and reposition the device.

The most commonly used retractors have been shown to increase complications and often necessitate the use of more challenging techniques for success:

The Nathanson liver retractor causes more liver dysfunction than V-LIST or the liver suspension technique and causes more postoperative pain than the liver suspension technique.¹
Suture suspension of the gallbladder yielded significantly lower complication rates compared with instrument usage (3.3% vs 13.3% p<0.0001)²
- Common intraoperative complications: gallbladder perforation, bile spillage and hemorrhage
- Common postoperative complications: wound infection and hematoma, bile leakage, and residual choledocholithiasis

A trend toward more minimally invasive laparoscopic approaches has led to techniques of single-incision and natural orifice laparoscopic surgery. Increased focus on reducing the number of incisions (cost, pain, and aesthetics) also contributes to the need for new retraction solutions.

An ideal method for liver retraction during laparoscopic upper abdominal surgery would lift the liver out of the operative field in a nontraumatic manner, providing adequate space for visualization and operation for as long as required, and without the need for additional ports or assistance. Reducing the number of abdominal incisions will improve cosmesis and reduce risks for wound complications and postoperative pain.³ In summary, an ideal solution will:

Utilize existing trocars
Remain completely intracorporeal
Optimize visualization
Provide for hands-free retraction

FreeHold Surgical Trio, Liver Retractor/Retraction Robotic Hiatal Hernia with Large Floppy Liver - Video