Elastic Intracorporeal Retraction in Laparoscopic Bariatric Surgery: Performance, Safety, and Multi-Organ Applications.

BACKGROUND

Effective organ retraction is essential for safe minimally invasive bariatric surgery. Traditional retraction techniques have notable limitations: rigid external retractors require subxiphoid incisions and are associated with hepatic trauma and biochemical liver injury, while handheld retractors require additional trocars, increasing complications and operative time. The Elastic Intracorporeal Retractor (EICR) was developed as a trocar-free, hands-free multi-organ retraction system.

OBJECTIVES

To evaluate the intraoperative performance, technical feasibility, and safety of the EICR in consecutive laparoscopic bariatric procedures.

SETTING

Tertiary care center.

METHODS

This retrospective study included 96 consecutive procedures performed between January 2022 and January 2025 by a single surgeon. The EICR (XNY Medical) was deployed through a standard 10-mm trocar. Primary outcomes included technical performance (first-attempt deployment, insertion time, repositioning). Secondary outcomes assessed safety through intraoperative events and 30-day outcomes. Independent blinded video review by an external surgeon evaluated 40 consecutive cases.

RESULTS

The EICR achieved first-attempt deployment in 99% of cases, with median insertion time of 95 s (IQR 75-115). Repositioning occurred in 10.4%; no additional retraction trocars were required in any case. The device was used for liver retraction in 89.6% of cases, with retraction of a structure other than the liver in 8 of 96 patients (8.3%): the oesophagus in 7 and the greater omentum in 1. Minor retraction-related complications occurred in 5.2% (four serosal tears <5 mm, one hook disconnection), all managed conservatively. Liver function tests in complication cases were within normal limits; systematic cohort-wide testing was not performed. No major complications, conversions, or reoperations occurred. Independent blinded review demonstrated complete concordance with documented outcomes.

CONCLUSIONS

Across 96 consecutive procedures with independent blinded video validation, the EICR provided reliable, reproducible organ retraction with a rapid deployment time, an acceptable intraoperative safety profile, and no requirement for additional retraction trocars. Retraction was also achieved beyond the liver in 8 of 96 patients (oesophagus, 7; greater omentum, 1). As an uncontrolled single-surgeon series, this study demonstrates feasibility; comparative effectiveness against existing retraction methods now warrants prospective controlled evaluation.