Simple and cost-effective liver retraction technique for laparoscopic right adrenalectomy - An initial experience from a tertiary care centre.

Abstract: Liver retraction is a critical step for optimal surgical exposure and preventing liver injury during right laparoscopic adrenalectomy (LA), due to the complex relationship of the suprarenal gland with the inferior vena cava and liver. Current retraction methods require specialised instruments like Nathanson and robotic retractors, which are challenging to procure in developing countries due to limited funding and resources. To overcome these challenges, we propose a technique for liver retraction using locally available basic laparoscopic tools, making LA more feasible in resource-limited settings. The patient was laid in the reverse Trendelenburg position and then laterally rotated to the left. Port 1, port 2 and port 3 were placed in a triangular configuration with the camera lying in situ in port 2, while ports 1 and 3 serve as working ports. Port 4 was made in the epigastrium, and a Maryland forceps or laparoscopic needle holder was introduced beneath the right liver lobe, supporting the liver uniformly. This surgical technique is characterised by its simplicity, feasibility and cost-effectiveness. It ensures reliable liver retraction while providing ergonomic benefits for surgeons and upholding both surgical safety and operational efficiency.