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We
now turn our attention to identifying a site along greater
curvature to initiate the proximal resection margin. The
omentum is cleared from this spot by cautery or ultrasonic
scalpel. Additional omental resection (e.g. in cases of
malignancy) may similarly be accomplished with
elctrocautery, clips, or the ultrasonic scalpel. A 12 mm
port is placed in the left abdomen, just lateral to the
HandPort to allow introduction of the linear stapler in a
proper orientation. The stomach will be divided form
greater to lesser curvature. The specimen may then be
removed through the HandPort. The base retractor functions
as an excellent wound retractor and wound protector. |
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Following
resection, s gastro-jejunostomy will need to be fashioned.
The hand is reintroduced and the abdomen insufflated. The
jejunum just distal to the ligament of Treitz is selected
and brought to the gastric remnant in an ante- or
retro-colic position, depending on surgeon’s preference.
An enterotomy is created in the antimesenteric portion of
small bowel and along the dependent portion of gastric
remnant (near the end of the staple line on the greater
curvature or posterior wall). Linear staplers are then
used to create the anastomosis (two 30 mm firings) through
the 12 mm port in the right abdomen.
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The
hand is extremely useful in helping to align and guide
this anastomosis. The initial enterotomies are then closed
by linear staplers introduced through the 12 mm port in
the left abdomen. The closure of enterotomies may
also be accomplished with sutures placed: a) totally
laparoscopically, or b) by standard open technique (non-pneumoperitoneum),
if the operative field is exposed through the HandPort
Base Retractor after the hand and Sleeve are removed. |
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