Operative Technique

Neuro Slimmer System Gastric Surgery Hypnosis

Neuro Slimmer System Gastric Surgery Hypnosis

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The patient is placed supine with the legs abducted. After pneumoperitoneum is established, trocar positions are plotted on the abdominal wall ( Fig. 16-1 ). A 10-mm port is placed through the left rectus muscle, 15 cm below the xiphoid process, for an angled operative laparoscope. Another 10-mm port is placed 11 cm down the left costal margin for the surgeon's right hand. A 5-mm trocar is inserted 20 cm along the left costal margin for retraction by the first assistant. A 5-mm port is then placed 15 cm down the right costal margin for the liver retractor, which is placed beneath the left lobe of the liver to expose the gastroesophageal (GE) junction and the gastrohepatic ligament above the hepatic branch of the vagus nerve. Finally, a 5-mm trocar is placed right-to-left through the falciform ligament and beneath the edge of the left liver lobe for the surgeon's left hand.

Dissection is initiated by opening the phrenoesophageal ligament above the hepatic branch of the vagus nerve, with circumferential dissection of the diaphragmatic

Figure 16-1 Orientation of port sites for most laparoscopic gastric procedures. The telescope, right- and left-hand ports, and GE junction form a diamond shape.

Figure 16-1 Orientation of port sites for most laparoscopic gastric procedures. The telescope, right- and left-hand ports, and GE junction form a diamond shape.

Figure 16-2 Highly selective vagotomy: division of anterior vagal branches (A) and division of posterior vagal branches (B). (Adapted from Spivak, H., and Hunter, J.G.: Laparoscopic gastric surgery. Prob. Gen. Surg. 14:82, 1997.)

Figure 16-4 A, Anterior lesser curve seromyotomy. B, Closure of the seromyotomy. (Adapted from Spivak, H., and Hunter, J.G.: Laparoscopic gastric surgery. Prob. Gen. Surg. 14:82, 1997.)

Figure 16-5 A, The Keith needle and attached anvil are passed though the posterior wall of the stomach 1 cm away from the dilator. B, The completed vertical banded gastroplasty. (A adapted from Johnson. A.B.. Oddsdottir. M.. and Hunter. J.G.: Laparoscopic Collis gastroplasty and Nissen fundoplication: A new technique for management of esophageal foreshortening. Surg. Endosc. 12:1055. 1998; B. from Chae. F. H.. McIntyre. R.C.. and Stiegmann. G.U.: Gastric and bariatic procedures. In Brooks. D.C. [ed.]: Current Review of Minimally Invasive Surgery. New York. Springer. ¡998. p. ¡¡2.)

Figure 16-6 The completed Roux-en-Y gastric bypass. (From Chae, F.H., Mclntyre, R.C., and Stiegmann, G.V.: Gastric and bariatic procedures. In Brooks, D.C. [ed.J: Current Review of Minimally Invasive Surgery. New York, Springer, 1998, p. 112.)

Figure 16-7 The completed adjustable silicone gastric banding. (From Chae, F.H., Mclntyre, R.C., and Stiegmann, G. V: Gastric and bariatic procedures. In Brooks, D.C. [ed.j: Current Review of Minimally Invasive Surgery. New York, Springer, 1998, p. 112.)

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