Trocar sites for laparoscopic ultrasound examination.
Schematic of peritoneal attachments of liver, which may need to be divided for full assessment of the hepatic surface. Generally this is not required, but the laparoscopist should be aware of the regional anatomy.
Laparoscope switched to right upper quadrant portal and passed into lesser sac through opening in avascular portion of gastrohepatic omentum. Traction on the stomach facilitates this maneuver.
Approach to the esophageal hiatus.
Trocar and needle placement for liver biopsy. The biopsy needle may be passed through a trocar or percutaneously through the abdominal wall.