{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T16:33:23Z","timestamp":1772987603715,"version":"3.50.1"},"reference-count":23,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T00:00:00Z","timestamp":1765756800000},"content-version":"vor","delay-in-days":348,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Asian J Endoscop Surgery"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Liver transaminase levels may be elevated following gastrectomy using the Nathanson liver retractor, which is widely used in laparoscopic gastrectomy. However, risk factors for developing liver dysfunction associated with this procedure remain unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Overall, 258 consecutive patients who underwent laparoscopic gastrectomy for gastric cancer using a Nathanson retractor between 2015 and 2022 were categorized into groups with and without Common Terminology Criteria for Adverse Event grade 3 or higher elevation in transaminases. Factors associated with transaminase elevation after laparoscopic gastrectomy were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Grade 3 or higher transaminase elevation was observed in 62 (24.0%) patients. Male sex, preoperative transaminase elevation, fatty liver, high body mass index, thickness of the lateral segment of the liver, D2 lymph node dissection, long operative duration, and high amount of blood loss were significantly associated with elevated transaminase levels in the univariable analysis. In the multivariable analysis, lateral segment thickness of the liver and operative duration were independent risk factors for postoperative elevation in transaminase levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Lateral segment thickness of the liver and operative duration were independent risk factors for transaminase elevation after laparoscopic gastrectomy using a Nathanson retractor. Although it is an easy and useful liver retractor, alternative methods of liver elevation should be considered in patients at risk of elevated postoperative liver enzyme levels.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ases.70214","type":"journal-article","created":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T07:29:13Z","timestamp":1765870153000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Lateral Segment Thickness of the Liver Is a Risk Factor for Elevated Liver Enzymes After Laparoscopic Gastrectomy Using the Nathanson Liver Retractor"],"prefix":"10.1111","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3081-7148","authenticated-orcid":false,"given":"Michihisa","family":"Iida","sequence":"first","affiliation":[{"name":"Department of Gastroenterological, Breast and Endocrine Surgery Yamaguchi University Graduate School of Medicine  Yamaguchi Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yusaku","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological, Breast and Endocrine Surgery Yamaguchi University Graduate School of Medicine  Yamaguchi Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiyo","family":"Nakashima","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological, Breast and Endocrine Surgery Yamaguchi University Graduate School of Medicine  Yamaguchi Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mitsuo","family":"Nishiyama","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological, Breast and Endocrine Surgery Yamaguchi University Graduate School of Medicine  Yamaguchi Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroto","family":"Matsui","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological, Breast and Endocrine Surgery Yamaguchi University Graduate School of Medicine  Yamaguchi Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7419-5638","authenticated-orcid":false,"given":"Yoshitaro","family":"Shindo","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological, Breast and Endocrine Surgery Yamaguchi University Graduate School of Medicine  Yamaguchi Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yukio","family":"Tokumitsu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological, Breast and Endocrine Surgery Yamaguchi University Graduate School of Medicine  Yamaguchi Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shinobu","family":"Tomochika","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological, Breast and Endocrine Surgery Yamaguchi University Graduate School of Medicine  Yamaguchi Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0050-3439","authenticated-orcid":false,"given":"Yuki","family":"Nakagami","sequence":"additional","affiliation":[{"name":"Department of Data Science, Faculty of Data Science Shimonoseki City University  Yamaguchi Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hidenori","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological, Breast and Endocrine Surgery Yamaguchi University Graduate School of Medicine  Yamaguchi Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroaki","family":"Nagano","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological, Breast and Endocrine Surgery Yamaguchi University Graduate School of Medicine  Yamaguchi Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,12,15]]},"reference":[{"key":"e_1_2_10_2_1","first-page":"146","article-title":"Laparoscopy\u2010Assisted Billroth I Gastrectomy","volume":"4","author":"Kitano S.","year":"1994","journal-title":"Surgical Laparoscopy & Endoscopy"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3181cc8f6b"},{"key":"e_1_2_10_4_1","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1007\/s10120-017-0747-0","article-title":"Short\u2010Term Outcomes in Minimally Invasive Versus Open Gastrectomy: The Differences Between East and West. 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