Intubation by looping. A. The sigmoidoscope is advanced to the distal sigmoid. B. Counterclockwise torquing during further advancement loops the proximal sigmoid in front of the distal sigmoid. C. The looped sigmoid flattens the angle at the distal-descen
Endoscopic view of a choledochojejunal anastomosis in a patient who had a gastrointestinal bleed. A laparoscopic side-to-side choledochojejunostomy had been performed 2 months previously for an unresectable distal cholangiocarcinoma causing obstructive j
View of pylorus. Bubbles indicating bile provide a clue to the location of the distal stomach when orientation of the side-viewing endoscope is difficult.
Manual compression proximal and distal to a selected segment allow insufflation. The lesion is visualized both by the endoscopist and by transillumination. (Reprinted with permission from Scott Conner CEH, Dawson DL. Operative Anatomy. Philadelphia: Lipp
Distal pancreatectomy with splenectomy. The figure demonstrates the proper angle of approach when transecting the pancreatic body with the 30-mm GIA stapler. The posterior aspect of the pancreas must be dissected completely to allow free passage of the st
Trocar placements for distal pancreatectomy. These sites are proper for both splenic salvage and with splenectomy. There should be at least a hand’s breadth distance between trocars 1, 3, and 4. The trocar for the laparoscope should be above the umbilicus
The endoscopic linear stapler is used to divide the bowel at the distal resection margin.
Suggested trocar placement for resection of distal small bowel lesions. For a more proximal lesion, move the left lower quadrant trocar to the left upper quadrant. Trocars 4 and 5 are per the surgeon’s preference.