Atlas of Minimally Invasive Surgical Operations by John G. Hunter Donn H. Spight Corinne Sandone Jennifer E. Fairman

Author:John G. Hunter, Donn H. Spight, Corinne Sandone, Jennifer E. Fairman
Language: eng
Format: epub
Publisher: McGraw-Hill Education LLC
Published: 2018-11-15T00:00:00+00:00

OPERATIVE PREPARATION A Foley catheter and orogastric tube are placed after induction of anesthesia. The surgeon must remember to have the anesthesiologist remove the orogastric tube from the stomach before the gastric pouch is created. The abdomen is prepped and draped to provide an adequate field should the operation be converted to laparotomy. The field should be draped far laterally to provide access for the liver retractor and first assistant’s retraction ports.

Trocar Placement The primary (camera) port should be in the midline, slightly cephalad to the umbilicus. In a patient with a very large belly (android fat distribution), the xiphoid should be used as the major landmark. The camera can be placed 20 to 25 cm caudad to the xiphoid. This position will allow adequate views of the ileocecal junction, the duodenum, and the greater curvature of the stomach. Two 12-mm trocars are placed, one in the left upper quadrant and one in the left midabdomen. These two trocars are used to manipulate the stomach during gastric resection and small bowel during creation of the alimentary limb, common channel, and duodenoenterostomy when applicable (FIGURE 2A). The left lower quadrant port is not necessary when only a sleeve gastrectomy is performed (FIGURE 2B). A 5-mm trocar is placed in the right upper quadrant. This trocar can be used by the assistant to help position the stomach during a sleeve resection or assist in the creation of the alimentary limb and common channel during BPDS. A fourth 12-mm trocar is placed in the right middle quadrant to assist in making the lateral gastrectomy. A 5-mm trocar is placed in the subxiphoid position to allow insertion of a Nathanson liver retractor.

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.