The patient is placed supine in a modified lithotomy position using Dan Allen stirrups. Surgery is begun in the Trendelenburg position (20° head-down tilt) and, after cannula insertion, the patient is tilted left side down for ileal surgery or the right side down for jejunal surgery.
The surgeon and assistants stand in a half circle opening toward the area of interest. Figure 8.1.1A shows the positions for ileal surgery. After cannula insertion, the surgeon stands between the legs and both assistants stand on the left side of the patient for the remainder of the procedure. The scrub nurse should stand on the right side near the knee. One monitor is placed close to the patient's right shoulder, the optimal position for viewing by the surgeon and assistants; the second monitor is placed near the left shoulder, the best location for viewing by the nurse. An alternative can be that one flat screen monitor is used, which is placed above the patient's head, for all members of the operative team to use (Figure 8.1.1B). For jejunal surgery, the setup is a mirror image of the ileal positions.
Table 8.1.1. Specific instruments recommended for laparoscopic small bowel resection
1 Dissecting device (i.e., LigaSure VTM or Ultrasonic Shears™ or electrosurgery) 1 Laparoscopic scissor
1 Laparoscopic dissector
2 Laparoscopic graspers
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