Image obtained during Laparoscopic Heller`s Cardiomyotomy.
Image obtained during Laparoscopic Heller`s Cardiomyotomy. Intracorporeal suturing of mucosal perforation.
Image obtained during Laparoscopic Heller`s Cardiomyotomy. A mucosal perforation was done during myotomy.
A. Completed abdominal myotomy with Toupet posterior fundoplication. B–D. Completed abdominal myotomy with Dor anterior fundoplication. (Reprinted with permission from Hunter et al, Laparoscopic Heller myotomy and fundoplication for achalasia. Ann Surg 1
The myotomy being carried distally, using hook electrocautery. Care must be taken to elevate the muscle fibers away from the mucosa before the electrocautery is applied. The myotomy extends about 5 to 6 cm proximal to the gastroesophageal junction and abo
Trocar placement. The supraumbilical trocar and the right subcostal trocar are placed 15 cm from the xiphoid, the left subcostal trocar about 10 cm from the xiphoid. The epigastric trocar is placed as high as the liver edge allows and as lateral as the fa
The operating room setup.