Background

The Penrose Barbed-Suture Internal Liver Retractor is a simple tool used in bariatric procedures for liver retraction without needing an external retractor, trocar, or needle extraction through the abdominal wall. Importantly, it does not interfere with robotic arms.Constructed as a simple and rapid homemade solution, the device is assembled on the back table using a 5 cm latex-free Penrose with a barbed suture on each side. One, measuring 10 cm, attaches to the falciform above the liver, while the other, measuring 20 cm, is initially attached to the right cross and later to the free edge of the falciform ligament. The barbed suture is a number one PDS suture with a CT-1 needle.During the procedure, the device is introduced under direct visualization. The 20 cm barbed suture is placed in the right cross, pulled until Penrose's first edge is attached, and the needle is left in place. The second barbed suture extends the Penrose against the free liver edge, attaching it to the falciform near the diaphragm. The needle is then cut for later extraction. Subsequently, the longer barbed suture is attached to the free edge of the falciform ligament for additional liver retraction in a 'V' configuration, followed by cutting and extracting both needles.A retrospective review of 469 robotic bariatric cases performed by a single surgeon from 01/01/2019 to 12/05/2023 demonstrated the successful use of the Penrose Barbed-Suture Internal Liver Retractor in Robotic Bariatric procedures.