Insertion of the Innerdyne gastric cannula into inflated stomach. Thereafter, the radially expandable polymer sheath is stretched by an 11.0-mm port for intragastric insertion of the operating laparoscope.
Construction of mucosa-lined tube (Janeway-style gastrostomy). A fold of stomach is elevated and the endoscopic stapler applied. Approximately 1 cm of stomach must be included in the staple line to assure an adequate lumen. The tube is grasped and elevate
The myotomy being carried distally, using hook electrocautery. Care must be taken to elevate the muscle fibers away from the mucosa before the electrocautery is applied. The myotomy extends about 5 to 6 cm proximal to the gastroesophageal junction and abo
Retract the stomach rightward and the spleen and omentum left and downward to complete mobilization of the fundus. These maneuvers open the lesser sac and facilitate division of the high short gastric vessels.
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.