Laparoscopic liver retraction device and method

Abstract

Laparoscopic liver retraction devices and related methods. In one embodiment, a laparoscopic liver retraction device includes a liver support member constructed from a stretchable, flexible support material, one or more puncture connectors attached to the periphery of the liver support member, and two or more flexible retraction elements attached to the periphery of the liver support member. Also described are surgical safety fasteners that can be used with laparoscopic liver retraction devices and related methods, by way of example and not limitation.

Description

[Technical Field]

[0001] (Reference to Related Application) This patent application claims the benefit of the filing date of and priority to U.S. Provisional Patent Application No. 63 / 373,494, filed August 25, 2022, for "Laparoscopic Liver Retraction Device and Method," the entire contents of which are incorporated herein by reference.

[0002] A liver retractor used in laparoscopic surgery. [Background technology]

[0003] Liver traction is a critical step in facilitating upper abdominal surgeries, such as gastrectomy, antireflux surgery (e.g., Nissen laparoscopic retraction), bariatric surgery (gastric bypass), and pancreatectomy (e.g., Whipple procedure). Because the liver is a heavy yet fragile organ, surgeons need a liver retractor that is easy to use, gentle on a wide area of the liver, yet strong enough to retract. Currently used laparoscopic liver retractors have significant drawbacks. For example, the Nathanson retractor has a high initial cost, requires significant skill and time for use, requires a relatively large incision, limits access to other instruments at the surgical site, and may injure the liver. Additionally, an improved Penrose drain has been proposed as a liver retractor, addressing some of the drawbacks of the Nathanson retractor. However, successful use of the improved Penrose drain requires relatively advanced techniques. Another example is the FreeHold Trio, a commercially available liver retractor. However, it is not widely used and is difficult to use because it uses a string that can potentially cut or injure the liver. Summary of the Invention

[0004] The laparoscopic liver retractor and methods presented herein provide a safe and easy way to lift and move the liver during laparoscopic upper abdominal surgery.

[0005] In one embodiment, a laparoscopic liver retraction device includes a liver support member constructed of a stretchable and flexible support material, the liver support member being convertible between a collapsed, laparoscopic introduction configuration and an expanded liver retraction configuration; a puncture connector attached to a periphery of the liver support member; a first elongated, flexible retraction element attached to a periphery of the liver support member; and a second elongated, flexible retraction element attached to a periphery of the liver support member, the puncture connector, the first retraction element, and the second retraction element being configured to connect the liver support member to the expanded liver retraction configuration. the puncture connector is located between the first and second retraction elements and spaced apart from one another around the periphery of the liver support member when the liver support member is in the position shown in FIG. 1, the liver support member has a curved shape, the first and second retraction elements are attached to an upper half of the curved shape, the puncture connector is attached to a lower half of the curved shape, the upper and lower halves each have an apex, the puncture connector is located relatively close to the apex of the lower half, and the first and second retraction elements are located relatively far from the apex of the upper half.

[0006] The puncture connector of this example may be a surgical safety fastener including (a) an elongated pin having a puncture end, and (b) a safety cover that may be movable between an extended configuration in which the safety cover prevents access to the puncture end and a retracted configuration in which the safety cover does not prevent access to the puncture end.

[0007] The safety cover of this embodiment may include a spring that biases the safety cover into the expanded configuration.

[0008] The safety cover of this embodiment may further comprise a cover portion and a second portion, and the spring may connect the cover portion to the second portion.

[0009] The cover portion of this embodiment may have an inner wall that may be located between the puncture end and the second portion both when the safety cover is in the extended configuration and when the safety cover is in the retracted configuration.

[0010] The laparoscopic liver retractor of this embodiment may use diaphragmatic crura hooks as puncture connectors.

[0011] The laparoscopic liver retractor of this embodiment may use at least one pair of diaphragmatic crura hooks positioned adjacent to each other.

[0012] Each of the hooks used in this embodiment may include a piercing end and a laparoscopic manipulation portion.

[0013] In this embodiment, the folded laparoscope introduction configuration may be a twisted configuration.

[0014] In another embodiment, a laparoscopic liver retraction device includes a liver support member constructed of a stretchable and flexible support material, the liver support member being convertible between a collapsed laparoscopic introduction configuration and an expanded liver retraction configuration, the liver support member having a liver support region surrounded by a periphery; a puncture connector attached to the periphery of the liver support member; a first elongated, flexible retraction element attached to the periphery of the liver support member; and a second elongated, flexible retraction element attached to the periphery of the liver support member, the puncture connector, the first retraction element, and the second retraction element being spaced apart about the periphery of the liver support member such that the puncture connector is located between the first retraction element and the second retraction element when the liver support member is in the expanded liver retraction configuration.

[0015] The puncture connector in this embodiment may be a diaphragm crura hook.

[0016] The laparoscopic liver retractor of this embodiment may include at least a pair of diaphragmatic crura hooks positioned adjacent to each other.

[0017] The diaphragmatic crura hook of this embodiment may include a piercing end and a laparoscopic operating portion.

[0018] The liver support member in this embodiment may be a flat membrane.

[0019] The planar membrane in this embodiment may be a silicone material.

[0020] In this embodiment, the flat film may be disk-shaped.

[0021] The liver support member in this embodiment may include a reinforcing portion extending around the periphery of the liver support member, and the puncture connector and the first and second traction elements may be connected to the reinforcing portion.

[0022] The reinforcement in this embodiment may comprise at least one of a thickened portion of the flexible liver support member or a separate reinforcement element.

[0023] The collapsed laparoscopically introduced configuration of the liver support member in this embodiment may be a twisted configuration.

[0024] In another embodiment, a method for laparoscopic liver retraction includes the steps of: introducing a laparoscopic liver retractor into an abdominal cavity while a liver support member of the liver retractor is in a collapsed configuration; expanding the liver support member to an expanded liver retraction configuration; connecting the liver support member to a diaphragmatic crus using a puncture connector attached to a periphery of the liver support member; and retracting the liver into the abdominal cavity by pulling a first elongated, flexible retraction element attached to a periphery of the liver support member and a second elongated, flexible retraction element attached to a periphery of the liver support member, wherein the first and second retraction elements are retracted outside the abdominal cavity such that the liver support member lifts and supports the liver.

[0025] In this embodiment, retracting the liver may include retracting a first retraction element through a first incision and retracting a second retraction element through a second incision spaced apart from the first incision.

[0026] In this embodiment, connecting the liver support member to the diaphragm crura using the puncture connector may include puncturing the diaphragm crura using at least a pair of adjacently arranged diaphragm crura hooks.

[0027] In this embodiment, the liver support member may be flat.

[0028] In this embodiment, the outer periphery of the liver support member has a curved shape, the first traction element and the second traction element are attached to the upper half of the curved shape, and the puncture connector is attached to the lower half of the curved shape.

[0029] In this embodiment, the upper half and the lower half each have a top, the diaphragm leg hook is positioned relatively close to the top of the lower half, and the first traction element and the second traction element are positioned relatively far from the top of the upper half.

[0030] In this embodiment, the liver support member is positioned relative to the liver so that the first and second retraction elements extend to opposite sides of the round ligament of the liver.

[0031] In this embodiment, retracting the liver may include retracting both the liver and the round ligament.

[0032] Also described herein are surgical safety fasteners that can be used in conjunction with the laparoscopic liver retraction devices and methods described herein, as well as for other applications. [Brief explanation of the drawings]

[0033] [Figure 1]FIG. 10 is a diagram showing an example of a laparoscopic liver retractor. [Figure 2] FIG. 10 shows an example of a twisted configuration of a laparoscopic traction tool. [Figure 3] FIG. 2 is a cross-sectional view of a liver support member of the traction device of FIG. 1. [Figure 4] FIG. 10 is a diagram showing an example of a puncture connector. [Figure 5] FIG. 1 is a diagram showing an outline of an example of a laparoscopic liver traction method. [Figure 6] FIG. 10 shows an example in which a laparoscopic liver retractor is used to lift the liver. [Figure 7] FIG. 1 is an enlarged view of an example of a surgical safety fastener. [Figure 8] FIG. 8 shows the surgical safety fastener of FIG. 7 in a traction configuration. [Figure 9] 10A-10C show another embodiment of a surgical safety fastener. [Figure 10] 10A-10C show other embodiments of the surgical safety fastener. DETAILED DESCRIPTION OF THE INVENTION

[0034] 1 illustrates an example of a laparoscopic liver retractor 100. The retractor 100 may be used to facilitate liver retraction during a variety of upper abdominal surgical procedures, including, but not limited to, gastrectomy (cancer, ulcer), bariatric bypass surgery (e.g., RY-gastric bypass), reflux surgery (e.g., Nissen fundoplication), splenectomy (e.g., Whipple procedure), and splenectomy. The laparoscopic liver retractor 100 provides a safe and easy method for lifting and moving the liver during these and other upper abdominal surgical procedures.

[0035] In the embodiment of FIG. 1, laparoscopic liver retractor 100 includes a liver support member 102, a piercing connector 104, and a retraction element 106.

[0036] The liver support member 102 is formed from a stretchable, flexible support material. The liver support member 102 may be made of a material that can support, lift, and move the liver during surgery with minimal trauma. In one embodiment, the liver support member 102 may be a disk-shaped, flat member made from a silicone material. In other embodiments, other shapes, configurations, and materials may be used. This material is soft enough to avoid trauma to the liver, yet strong enough to lift a heavy liver from underlying or adjacent organs. In some embodiments, the liver support member may be disk-shaped (circular, oval, triangular, heart-shaped) and flexible.

[0037] The liver support member 102 in this embodiment is convertible between a collapsed laparoscopic introduction configuration, shown in FIG. 2, and an expanded liver retraction configuration, shown in FIG. 1. When in the expanded configuration of FIG. 1, the liver support member 102 has a diameter or other maximum dimension ranging from 5 cm to 20 cm. The liver support member 102 is generally sized to cover at least a portion of the liver during surgery and to lift the liver when force is applied to the retraction element 106. When in the laparoscopic introduction configuration of FIG. 2, the liver support member 102 is twisted or otherwise reduced in size to allow passage of cannulated laparoscopic instruments (e.g., having an inner diameter ranging from 5 to 19 mm or an inner diameter ranging from 10 to 14 mm). The inner diameter of the cannulated laparoscopic instruments is generally indicated by reference numeral 108 in FIG. 2.

[0038] As shown in FIG. 1 , the liver support member 102 has a perimeter 110 that surrounds the liver support region of the liver support member 102. In this embodiment, the puncture connector 104 and the retraction element 106 are attached to the perimeter 110 of the liver support member 102. In this embodiment, the perimeter 110 has a reinforcement portion 112 that extends around the liver support member 102. The reinforcement portion 112 has a thicker cross-section than the rest of the liver support member 102 and is the portion to which the puncture connector 104 and the retraction element 106 connect. FIG. 3 is a cross-sectional view of the liver support member 102 and the thickened reinforcement portion 112. In other embodiments, the perimeter of the liver support member may be reinforced in other ways, such as with a separate element embedded in the perimeter of the liver support member or attached in other ways to the perimeter of the liver support member.

[0039] FIG. 4 shows the puncture connector 104 in more detail. In this embodiment, the puncture connector 104 is a diaphragmatic crura hook. The puncture connector 104 is shaped, configured, and positioned relative to the other elements of the retractor 100 so that the puncture connector 104 can puncture and engage the diaphragmatic crura during use. The diaphragmatic crura are muscular, strong areas that provide support for the disc during use. The puncture connector 104 includes a puncture end 114 for puncturing the diaphragmatic crura, a connector end 116 that connects to the liver support member 102, and a laparoscopic manipulation portion 118 between the puncture end 114 and the connector end 116. The laparoscopic manipulation portion 118 is configured to be engaged with a laparoscopic instrument (e.g., a laparoscopic grasper / forceps).

[0040] In the example of FIG. 4, the connector end 116 has an opening to which the liver support member 102 is connected. The manipulation portion 118 in this example is a sleeve (e.g., made of rubber or plastic) to facilitate manipulation with laparoscopic instruments. In other embodiments, the manipulation portion may have a different surface texture to increase friction, or may have raised surfaces and / or protrusions designed to accommodate laparoscopic graspers. The piercing end 114 in the example of FIG. 4 has metallic double hooks designed to pierce tissue such as the diaphragm crus. In other embodiments, other numbers of hooks may be used. The piercing connector 104 may have a size ranging from 1 to 5 cm, and the piercing end hooks may have a diameter of 3 to 10 mm.

[0041] In the example shown in FIG. 1 , the retractor 100 includes a pair of puncture connectors 104 positioned adjacent to one another. "Adjacent" here means that the pair of puncture connectors 104 are connected to the liver support member 102 with sufficient spacing between them to allow both puncture connectors 104 to engage the diaphragmatic crura. In some embodiments, the puncture connectors 104 are spaced between 0 mm and 20 mm apart at their connections with the liver support member 102. While FIG. 1 shows the retractor 100 with two puncture connectors 104, other numbers of connectors may be used in other embodiments. In some embodiments, the use of multiple puncture connectors 104 can reduce and distribute the amount of force a single connector exerts on an anatomical structure, reducing the risk of tearing or other undesirable damage to the anatomical structure.

[0042] In the illustrated embodiment, the retraction device 100 includes a pair of retraction elements 106 connected to the liver support member 102. The retraction elements 106 may be elongated and flexible, such as sutures or string. The retraction elements 106 may be sufficiently elongated so that they extend from the liver support member 102 through the abdominal wall and outside the patient's anatomy, allowing them to be manipulated outside the anatomy to retract the liver. For example, a suture passer can be inserted through a separate incision, and the surgeon can pull the retraction elements 106 out through the abdominal wall and clamp them at skin level using conventional surgical clamps. For example, once the appropriate tension and liver height / retraction amount is achieved, the retraction elements can be secured externally using a tourniquet or clamp.

[0043] In one embodiment, the length of the traction element 106 may be at least 5 cm.

[0044] As shown in FIG. 1 , the puncture connectors 104 and the retraction elements 106 are spaced apart around the periphery of the liver support member 102, such that the puncture connectors 104 are positioned between the retraction elements 106 when the liver support member 102 is in the expanded liver retraction configuration. In this embodiment, the periphery 110 of the liver support member 102 has a curved shape, the retraction elements 106 are attached to an upper half 120 of the curved shape, and the puncture connectors 104 are attached to a lower half 122 of the curved shape. The upper and lower halves 120 and 122 have apexes 124 and 126, respectively, with the puncture connector 104 positioned relatively close to the apex 126 of the lower half and the retraction elements 106 positioned relatively far from the apex 124 of the upper half. The relative positions of the puncture connectors 104 and the retraction elements 106 facilitate optimal positioning and use of the laparoscopic liver retractor 100.

[0045] FIG. 5 is a diagram illustrating an example of a laparoscopic liver retraction method 200. The method 200 may use the laparoscopic liver retractor 100 of FIGS. 1-4 or a retractor with a different configuration. The method 200 begins in step 202, where a laparoscopic liver retractor is introduced into the abdominal cavity while the liver support member of the liver retractor is in a collapsed configuration. Then, in step 204, the support member is expanded to an expanded liver retraction configuration. Then, in step 206, a puncture connector attached to the periphery of the liver support member is used to connect the support member to the diaphragmatic crus. Then, in step 208, the liver is retracted into the abdominal cavity by pulling an elongated, flexible retraction element attached to the periphery of the liver support member. The retraction element is retracted outside the abdominal cavity so that the liver support member lifts and supports the liver.

[0046] FIG. 6 illustrates the laparoscopic liver retractor 100 of FIGS. 1-4 being used to retract the liver 302 in accordance with the method 200 of FIG. 5. In the embodiment of FIG. 6, the puncture connector 104 punctures and engages the crus of the diaphragm in step 204, with the retraction element 106 extending outside the abdominal cavity. As also seen in FIG. 6, the laparoscopic liver retractor 100 is positioned so that the retraction element 106 extends on the opposite side of the round ligament of the liver 306, allowing simultaneous retraction of both the round ligament of the liver 306 and the liver 302. As seen in FIG. 6, the liver support member of the retractor is circular in nature, however, pressure from the puncture connector at the bottom and the retraction element at the top may cause the support member to assume a somewhat triangular shape during use.

[0047] Figures 7 and 8 show a surgical safety fastener that can be used as a puncture connector in place of the puncture connector 104 shown in Figure 4. The surgical safety fastener of Figures 7 and 8 can be used with a laparoscopic liver retractor such as the embodiment described above. The surgical safety fastener of Figures 7 and 8 can also be used for other purposes.

[0048] 7, the surgical safety fastener includes two elongated pins 702 and a safety cover 704. Each of the elongated pins 702 has a piercing end 706. The safety cover 704 is movable between an extended configuration (shown in FIG. 7), in which the safety cover 704 blocks access to the piercing end 706, and a retracted configuration (shown in FIG. 8), in which the safety cover 704 does not block access to the piercing end.

[0049] The safety cover 704 has a cover portion 708, a second portion 710, and a spring 712. The spring 712 connects the cover portion 708 to the second portion 710 and biases the safety cover 704 into the extended configuration. The cover portion 708 has an inner wall 714. The inner wall 714 is located between the puncture end 706 of the elongated pin 702 and the second portion 710 of the safety cover 704. The inner wall 714 is located between the puncture end 706 of the elongated pin 702 and the second portion 710 of the safety cover 704 both when the safety cover 704 is in the extended configuration (as shown in FIG. 7) and when the safety cover 704 is in the retracted configuration (as shown in FIG. 8).

[0050] 7 and 8, the safety cover 704 is collapsible to move away from the piercing end 706 of the elongated pin 702 toward the second portion 710 and move from the extended configuration shown in FIG. 7 to the retracting configuration shown in FIG. 8. When in the retracting configuration, the piercing end 706 is exposed (e.g., to pierce the diaphragm crus or other anatomical structure where the surgical safety fastener is to be secured). When the safety cover 704 is released, the safety cover 704 returns to the extended configuration, obstructing the piercing end 706 and preventing it from unintentionally piercing the patient's anatomy or other features.

[0051] Safety cover 704 has a gripping surface 716 that facilitates manipulation of the fastener with a gripping tool (such as robotic windowed gripper 718 shown in FIG. 8). In the particular embodiment shown in FIGS. 7 and 8, gripping surface 716 is flat, but may have other configurations to optimize interaction with the gripper. The shape and size of the fastener may be configured in other ways for use with typical robotic grippers.

[0052] 7 and 8, the inner wall 714 is part of a ledge formed on the cover portion 708 and is configured to block access to the puncturing end 706 of the elongated pin 702 when the safety cover 704 is in the extended configuration. In the embodiment shown in FIGS. 9 and 10, the inner wall 714 is part of a cavity formed on the cover portion 708. The cavity is configured to block access to the puncturing end 706 of the elongated pin 702 when the safety cover 704 is in the deployed configuration. In all embodiments shown in FIGS. 7-10, the inner wall 714 interacts with the puncturing end 706 to both block access to the puncturing end 706 and limit how far the cover portion 708 can move away from the second portion 710 in response to the biasing force applied by the spring 712.

[0053] In some embodiments, the cover portion 708, the second portion 710, and the spring 712 may all be part of a unitary body, while in other embodiments, the cover portion 708, the second portion 710, and the spring 712 may be separate elements joined together.

[0054] As shown in the embodiment of Figures 7-10, the elongated pin(s) 702 extend from the second portion 710 and curve back towards the cover portion 708. As shown in Figures 7-10, the safety catch may include one or more elongated pins 702.

[0055] The laparoscopic liver retraction device and method, and the surgical safety fastener described above, are provided by way of example, and additions, deletions, substitutions, modifications, and other changes may be made without departing from the scope or spirit of the invention.

Claims

1. A laparoscopic liver retraction device, comprising: (a) a liver support member constructed from a stretchable and flexible support material, the liver support member being convertible between a collapsed, laparoscopically guided configuration and an expanded, liver retraction configuration, the liver support member having a liver support region surrounded by a periphery; (b) a puncture connector attached to the outer periphery of the liver support member; (c) a first traction element that is elongated and flexible and attached to the outer periphery of the liver support member; (d) a second elongated, flexible traction element attached to the outer periphery of the liver support member; Equipped with the puncture connector, the first retraction element, and the second retraction element are spaced apart about the periphery of the liver support member such that the puncture connector is located between the first retraction element and the second retraction element when the liver support member is in the expanded liver retraction configuration; the liver support member has a curved shape, the first and second retraction elements are attached to an upper half of the curved shape, and the puncture connector is attached to a lower half of the curved shape; the upper half and the lower half each have an apex, the puncture connector is positioned relatively close to the apex of the lower half, and the first retraction element and the second retraction element are positioned relatively far from the apex of the upper half.

2. The piercing connector is a surgical safety fastener comprising: (a) an elongated pin having a piercing end; and (b) a safety cover; 10. The laparoscopic liver retractor of claim 1, wherein the safety cover is movable between an extended configuration in which the safety cover prevents access to the puncture end and a retraction configuration in which the safety cover does not prevent access to the puncture end.

3. The laparoscopic liver retractor of claim 2 , wherein the safety cover further comprises a spring biasing the safety cover into the expanded configuration.

4. The laparoscopic liver retractor of claim 3 , wherein the safety cover further comprises a cover portion and a second portion, and the spring connects the cover portion to the second portion.

5. The cover portion has an inner wall, 5. The laparoscopic liver retractor of claim 4, wherein the inner wall is located between the piercing end and the second portion both when the safety cover is in the expanded configuration and when the safety cover is in the retracting configuration.

6. The laparoscopic liver retractor of claim 1 , wherein the puncture connector comprises a diaphragmatic crura hook.

7. The laparoscopic liver retractor of claim 1 , wherein the collapsed laparoscopic introduction configuration of the liver support member has a twisted configuration.

8. A laparoscopic liver retraction device, comprising: (a) a liver support member constructed from a stretchable and flexible support material, the liver support member being convertible between a collapsed, laparoscopically guided configuration and an expanded, liver retraction configuration, the liver support member having a liver support region surrounded by a periphery; (b) a puncture connector attached to the outer periphery of the liver support member; (c) a first traction element that is elongated and flexible and attached to the outer periphery of the liver support member; (d) a second elongated, flexible traction element attached to the outer periphery of the liver support member; Equipped with the puncture connector, the first retraction element, and the second retraction element are spaced apart about the periphery of the liver support member such that the puncture connector is located between the first retraction element and the second retraction element when the liver support member is in the expanded liver retraction configuration. Laparoscopic liver retraction.

9. The laparoscopic liver retractor of claim 8 , wherein the puncture connector comprises a diaphragmatic crura hook.

10. The laparoscopic liver retractor of claim 9 , wherein the diaphragmatic crural hooks comprise at least a pair of diaphragmatic crural hooks disposed adjacent to each other.

11. The laparoscopic liver retractor of claim 10 , wherein each of the diaphragmatic crura hooks comprises a piercing end and a laparoscopic operating portion.

12. The laparoscopic liver retractor of claim 10 , wherein the liver support member comprises a flat membrane.

13. The laparoscopic liver retractor of claim 12 , wherein the planar membrane comprises a silicone material.

14. The laparoscopic liver retractor of claim 12 , wherein the flat membrane comprises a disk.

15. 11. The laparoscopic liver retraction device of claim 10, wherein the liver support member further comprises a reinforcing portion extending around an outer periphery of the liver support member, and the puncture connector and the first and second retraction elements are connected to the reinforcing portion.

16. 16. The laparoscopic liver retractor of claim 15, wherein the reinforcement portion comprises at least one of a thickened portion of the flexible liver support member or a separate reinforcement element.

17. The laparoscopic liver retractor of claim 10 , wherein the collapsed laparoscopic introduction configuration of the liver support member has a twisted configuration.

18. A laparoscopic liver traction method, comprising: (a) introducing a laparoscopic liver retractor into the abdominal cavity while a liver support member of the liver retractor is in a collapsed configuration; (b) expanding the liver support member to an expanded liver retraction configuration; (c) connecting the liver support member to the diaphragmatic crura using a puncture connector attached to the periphery of the liver support member; (d) retracting the liver into the abdominal cavity by retracting a first elongated, flexible retraction element attached to the periphery of the liver support member and a second elongated, flexible retraction element attached to the periphery of the liver support member; Including, The first and second retraction elements are retracted to the outside of the abdominal cavity so that the liver support member lifts and supports the liver.

19. 20. The method of claim 18, wherein retracting the liver comprises retracting a first retraction element through a first incision and retracting a second retraction element through a second incision spaced from the first incision.

20. 20. The method of claim 19, wherein connecting the liver support member to the diaphragm crura using the puncture connector comprises puncturing the diaphragm crura using at least a pair of adjacently arranged diaphragm crura hooks.

21. 21. The method of claim 20, wherein the liver support member is flat.

22. 22. The method of claim 21, wherein the periphery of the liver support member has a curved shape, the first and second retraction elements are attached to an upper half of the curved shape, and the puncture connector is attached to a lower half of the curved shape.

23. 23. The method of claim 22, wherein the upper half and the lower half each have an apex, the diaphragm crest hook is positioned relatively close to the apex of the lower half, and the first retraction element and the second retraction element are positioned relatively far from the apex of the upper half.

24. 24. The method of claim 23, wherein the liver support member is positioned relative to the liver such that the first and second retraction elements extend to opposite sides of the round ligament of the liver.

25. 25. The method of claim 24, wherein retracting the liver comprises retracting the liver and retracting the round ligament.

26. (a) an elongated pin having a piercing end; (b) a safety cover movable between an extended configuration that blocks access to the puncture end and a retracted configuration that does not block access to the puncture end; A surgical safety fastener comprising:

27. 27. The surgical safety fastener of claim 26, wherein the safety cover further comprises a spring biasing the safety cover into the expanded configuration.

28. the safety cover further comprises a cover portion and a second portion; the spring connects the cover portion to the second portion.

28. The surgical security fastener of claim 27.

29. The cover portion has an inner wall, 30. The surgical safety fastener of claim 28, wherein the inner wall is located between the piercing end and the second portion both when the safety cover is in the extended configuration and when the safety cover is in the retracted configuration.

30. the cover portion further includes a cavity that receives the puncture end when the safety cover is in the expanded configuration; The inner wall is located within the cavity.

30. The surgical security fastener of claim 29.

31. 30. The surgical security fastener of claim 28, wherein the elongated pin extends from the second portion.

32. 32. The surgical security fastener of claim 31, wherein the elongated pin curves back toward the cover portion.

33. 30. The surgical safety fastener of claim 28, wherein the safety cover is collapsible to move the cover portion toward the second portion and away from the piercing end of the elongate pin and from the extended configuration to the retracted configuration.

34. 30. The surgical security fastener of claim 28, wherein the cover portion has a gripping surface and the second portion has another gripping surface.

35. 35. The surgical security fastener of claim 34, wherein the gripping surface of the cover portion and the gripping surface of the second portion are flat gripping surfaces.

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