Surgical field—Laparoscopic view- Bowel perforation due to excessive pushing of stapler during laparoscopic gastrojejunostomy anastomosis.
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.
Trocar placement for transabdominal right adrenalectomy. Four 10-mm working trocars are used; if a vascular stapler is needed, one of these can be changed to a 12-mm port.
Placement of trocars in laparoscopic transabdominal left adrenalectomy. Three 10-mm trocars are usually placed initially; if a vascular stapler is needed, the middle trocar can be changed to a 12-mm port.
The stapler has been fired and removed. The staple line has been inspected for hemostasis and is being closed with a simple running suture.
Stay sutures have been placed and tied. Two enterotomies have been made and the stapler is inserted into the two enterotomies. The bowel and gallbladder must be carefully positioned to fully utilize the entire length of the stapling device (by pulling the
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
The colon is retracted toward the anterior abdominal wall as the vascular pedicle is divided with the linear cutting stapler.
The anvil is attached to the circular stapler (which has been passed transanally); the stapler will be closed and fired in the usual fashion.
A. The anvil of the circular stapler is inserted in the proximal end of the bowel (which has been drawn out of the abdomen through an enlarged trocar site). B. The pursestring suture is tied. The bowel is then returned to the abdomen.