Sagittal view of extraperitoneal dissection. A space is developed between peritoneum and abdominal wall. Note that the bladder is mobilized downward.
Trocar placement for transperitoneal iliac node dissection.
Trocar placement for retroperitoneal aortic node dissection.
Trocar placement for upper abdominal dissection.
Room setup and patient position for iliac node dissection.
Room setup and patient position for upper abdominal node dissection.
The small bowel segment chosen for resection has been suspended by traction sutures passed through the anterior abdominal wall. This facilitates subsequent dissection of mesenteric vessels and provides retraction without additional graspers or trocars.
Dissection of the left crus. The left crus is dissected as completely as possible, and the attachments of the fundus of the stomach to the diaphragm are taken down.
Initial dissection of the esophageal hiatus. The right crus is identified and dissected toward its posterior confluence with the left crus.
Ultrasonic adhesiolysis of omental adhesions to the abdominal wall