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NOVEL TRACTION TECHNIQUE USING BARBED SUTURE COMBINED WITH FREE JAW (FJ) CLIP.
Nao Kawaguchi
*, Yasuhiko Ueda, Shuhei Kushiyama, Atsushi Tomioka, Koji Komeda, Mitsuhiro Asakuma, Sang-Woong Lee
Osaka Ika Yakka Daigaku, Takatsuki, Osaka, Japan
Background: The creation of an adequate surgical plane through optimal traction is paramount in surgical procedures. In laparoscopic surgery, and particularly in reduced port surgery, establishing a proper surgical field is notably more technically challenging than in traditional open surgery. The Free Jaw (FJ) clip, developed in collaboration with Charmant Inc., located in Sabae City, Fukui, Japan, is known for its strong clamping force and minimal tissue damage. It has been available as a medical device for laparoscopic surgery since 2016.
Methods: We combined the FJ clip with barbed sutures (FJB) to improve the visual field through liver traction on the head side in single-port cholecystectomy (SPC). Following the adoption of the glove method in 2009, our institution has successfully completed over 1,500 cases of SPC, thereby standardizing this procedure. To further streamline this technique, we implemented the FJ clip coupled with a barbed suture. To simplify the technique, we introduced the FJ clip with barbed suture (FJB) method. From September 2023 to April 2024, 23 cases of SPC using the FJB method were performed at our institution by four surgeons. The cases included 19 cases of cholecystolithiasis, 2 cases of gallbladder polyp, and 2 cases of acute cholecystitis.
Procedure is as follows
The FJ clip was attached to the liver.
A barbed suture was strategically anchored to the diaphragm to optimize the direction and efficacy of liver traction.
Adjustments to the suture were made as necessary throughout the surgery to maintain optimal traction and stability.
Results: The mean installation time, measured from the insertion of the FJ clip to its anchoring at the diaphragm, was recorded at 165 seconds, with a range of 81 to 275 seconds. Notably, there were no post-operative liver effects observed, including in five cases involving fatty liver conditions. Moreover, no cases of intraoperative FJ clip detachment were observed.
Conclusion: The FJB method allows for effective countertraction and provides a clear view of the surgical field. It is a reproducible, safe, and adaptable technique, even for less experienced surgeons, and may serve as a valuable option for SPC.
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