Videos and Text Contributors
Amy Banks Venegoni
PATIENT POSITIONING AND TROCAR PLACEMENT
Surgeons choose one of two patient positions for laparoscopic foregut surgery.
Supine position is utilized with the Surgeon to the patient’s right, and the first
assistant on the patient’s left. The patient’s arms are both out and all pressure
pints are adequately padded. Trocars are then placed with the camera (using a
30 degree or greater angled scope) on the left and the assistant’s trocar in the
mid clavicular line on the left approximately 3 finger breadths below the rib cage.
The surgeon’s trocars are to the right in the paramedian line and in the mid
clavicular line on the right approximately 3 finger breadths below the rib cage.
The liver retractor is in the mid epigastrium
Split leg position requires a split leg table or use of stirrups. The Surgeon is in
between the legs and the assistant is to the patient’s left. All pressure points
have to be well padded. Both the patient’s arms are out. The camera trocar is to
the left and superior to the umbilicus, approximately 15 cm from the xiphoid
process. The assistant’s trocar is to the left in the anterior axillary line at or
above the level of the umbilicus. Both of the surgeon’s trocars are in the mid
clavicular line approximately 2 finger breadths below the ribcage. The liver
retractor can be in the right anterior axillary line or in the mid epigastrium as
shown in the videos below.