Patient Positioning and Operating Room Setup

We fix the body with the right side of the patient lower than the left (about 15°) using the "magic bed" (bean bag moldable device) and provide lateral support on the right side. We always use intermittent lower extremity compression stockings and adjustable leg stirrups. With regard to the head, we apply a foam pad to the forehead, and fix it there to the bed with adhesive tapes. The surgeon stands to the right side of the patient, the cameraman (second assistant) stands to the left side of the surgeon, and the first assistant stands in between the legs or on the left side of the patient (Figure 8.5.1). After initial exploration within the abdominal cavity in a neutral position, the patient is tilted into a right side down position, positioning the small intestines to the

Laparoscopic Low Anterior Resection
Figure 8.5.1. Positions of the equipment and the surgical team for the laparo-scopic anterior resection for rectal cancer.

right upper quadrant, with confirmation of the lesion site either by visualizing the tumor or an India ink marking placed on the bowel preoperatively. The small intestines are best positioned out of the way using specialized bowel grasping forceps with rounded tips. If necessary, the patient should be positioned head down (Trendelenburg position).

Table 8.5.1. Specific instruments recommended for laparoscopic rectal resection

5

Cannulae (3 X 12 mm, 3 X 5 mm)

1

Dissecting device (i.e. LigaSure VTM or Ultrasonic Shears™ or

electrosurgery)

1

Laparoscopic scissors

1

Laparoscopic dissector

1

Laparoscopic right-angled dissector

2

Laparoscopic graspers

1

Endoloop retractor

1

Endoscopic stapler

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  • Riikka
    Who stands on either side of the surgeon in the or?
    8 years ago

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