Patient
Preparation and Positioning
Routine
patient specific preoperative preparations are followed.
Prophylactic antibiotics are administered in the holding area.
Patients are placed on an adjustable operating room table
(preferably electric) in the supine position, arms at
patient’s sides (left may be extended). General anesthesia is
administered and a nasogastric and Foley catheter placed. The
patient is prepped and draped from nipples to groin. The surgeon
stands on the patient’s right side with scrub nurse opposite.
The camera
operator stands opposite the surgeon and may serve as an
assistant during the later course of the subtotal procedure. The
first assistant stands on the same side of the surgeon and
primarily serves to retract the liver (this assistant may be
replaced by a mechanical retracting device attached to the
operating room table). The monitor is placed off both sides of
the patient’s shoulders. A gastroscope should be available.
Pneumoperitoneum
may be achieved by Veress needle or open technique. A 10 mm
trocar is placed in the umbilicus and a 30 degree 10 mm
laparoscope is used for initial exploration after insufflating
to 15 Hgmm.
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