The mesoappendix is divided serially with clips, ligatures, or other hemostatic devices. Both the endoscopic stapler and the ultrasonic scalpel may also be used for this purpose.
The stomach is exposed and mobilized. A gastric balloon catheter may be used to define the pouch and facilitate pouch creation. (Soper NJ, Swanstrom LL, Eubanks WS, eds. Mastery of Endoscopic and Laparoscopic Surgery. 2d ed. Philadelphia: Lippincott Willi
Surgeon using nondominant (left) hand to palpate the head of the stapler/tacking device through the anterior abdominal wall, thus verifying stapler/tacking device position relative to external landmarks and providing counterpressure.