An Innovative Liver Retraction Technique Using FJ Clips Combined With Barbed Sutures in Single Port Cholecystectomy: The FJB Method

Abstract

Background

Single port cholecystectomy (SPC) provides several postoperative advantages including excellent cosmetic outcomes; however, it presents technical challenges due to impaired triangulation and restricted instrument mobility. To address these challenges, we developed the FJB method, a novel liver retraction technique combining Free Jaw (FJ) clips with barbed sutures.

Methods

In the FJB method, an FJ clip is applied near the base of the gallbladder, and a barbed suture is anchored to the diaphragm, enabling cephalad traction via a pulley-like mechanism. We evaluated the clinical feasibility and safety of this technique during SPC.

Results

Between September 2023 and April 2024, 23 SPC procedures utilizing the FJB method were performed by four surgeons at our institution. The mean installation time for the traction system was 165 seconds (range, 81-275 seconds). No intraoperative clip dislodgement, liver injury, or traction related complications were observed, including in patients with fatty liver. The FJB method consistently provided stable liver retraction, improved surgical visibility, minimized instrument collisions, and contributed to safer and more efficient procedures.

Conclusions

The FJB method is a simple, effective, and reproducible approach for achieving stable liver traction during SPC. It offers significant advantages in enhancing surgical safety and increasing overall procedural efficiency.