Figure 17
Trocar placement for laparoscopic Nissen fundoplication. The pneumoperitoneum
is maintained at 15 mm Hg. In patients with a large abdomen or a long distance
between umbilicus and xiphoid process, a supraumbilical incision is made
for the insertion of the video camera. Five more trocars are introduced
under visual control. A 10-mm trocar in the left upper quadrant is necessary
for placement of an endoscopic Babcock clamp. A 10-mm trocar is placed at
the upper midline for a fan retractor. A trocar is placed in the far right
lateral aspect of the costal margin for placement of a second endoscopic
Babcock clamp. The triangle describes the trocar placement for the surgeon
operating two handed at the base of the triangle. The trocars should be
placed as high as possible to allow them to reach the hiatus. The apex of
the triangle faces the gastroesophageal junction.
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