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.
The Laparolift is a powered articulating arm that attaches to the operating table. The arm lifts up on the lifting device, providing upward displacement of the anterior abdominal wall and producing retraction.
Both a fan-shaped and an inflatable donut-shaped device are available. Each is inserted into the abdomen in a collapsed configuration, then expanded within the peritoneal cavity.
Boundaries of “minimal stress triangle” described by Tyagai et al. Incisions placed within this triangle are well tolerated.
Diagram demonstrating the placement of flexible tubing or wire in combination with low-pressure pneumoperitoneum: (A) Banting et al. (1993), (B) Inoue et al. (1993), (C) Go et al. (1995). These techniques can be adapted using readily available materials a