Patient Positioning and Operating Room Setup

The patient is placed in the supine position with abducted arms and supports mounted to the sites of the table which allow safe tilting and lateral rotation of the operating table. A nasogastric tube and urinary catheter are placed. If a long intestinal tube is placed in the preoperative period, we do not place a nasogastric tube. Preoperative antibiotics are administered with gram-negative and anaerobic coverage to prevent surgical site infection. Two video monitors are used: Principally, the video monitor to the patient's right is positioned inferiorly at the level of hip and the monitor to the left positioned superiorly at the level of the shoulder. This positioning forms a plane parallel to the root of the superior mesenteric artery and allows the operating surgeon to look and work in the same direction as the camera orientation. But the configuration of the operating room arrangement should be flexible to permit modifications during the operation. For instance, for right-sided adhesions, the surgeon should operate from the left, with the monitor placed on the patient's right (Figure 10.3.1A). The inverse positions should be arranged for left-sided adhesions (Figure 10.3.1B). The surgeon can stand at the patient's right for midline adhesions or those on both sides.

Position Malade Sur Table Operation
Figure 10.3.1. Positions of the surgical team and equipment for laparoscopic adhesiolysis. A Setup for the situation in which adhesions are primarily on the right side. B Setup for the situation in which adhesions are primarily of the left side.
Equipment Set The Operating Room
Figure 10.3.1. Continued

Patients should be prepared and draped in a way that allows rapid conversion to an open procedure when necessary.

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