The Left Upper Quadrant

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By sweeping the laparoscope across the abdomen to the left side and tilting the left side of the body up, segments II and III of the liver can be easily inspected (Figure 7.5, see color plate). The esophageal hiatus, the caudate lobe through the hepatogastric ligament, and the cardia of the stomach can be demonstrated by lifting up the left lobe with atrau-matic grasper (Figure 7.6). Also demonstrable is the undersurface of the left hemidiaphragm, and the spleen. The splenic flexure, the sple-nocolic ligament, and the omentum may be easily visualized, along with the transverse colon (Figure 7.7, see color plate). The body of the pancreas may often be seen indenting the transverse mesocolon in the left upper quadrant (LUQ) as well.

Pancreas Mesocolon
Figure 7.5. Just to the left of the falciform ligament, segments II and III are easily visualized in most patients. (See color plate.)
Laparoscopic Falciform Ligament Images
Figure 7.6. By lifting up segments II and III of the liver, the lesser sac and the caudate lobe of the liver (segment I) may often be seen in thin patients. P, pancreas.
Flexure Thin Plate

Figure 7.7. The splenic flexure may be seen by lifting the omentum cephalad. In this thin patient, many of the left colonic vessels and retroperitoneal structures are seen. SF, splenic flexure; Pb, pancreatic body; LbMCA, left branch of the middle colic artery; RV, renal vein; RA, renal artery; K, kidney; LCA, left colic artery. (See color plate.)

Figure 7.7. The splenic flexure may be seen by lifting the omentum cephalad. In this thin patient, many of the left colonic vessels and retroperitoneal structures are seen. SF, splenic flexure; Pb, pancreatic body; LbMCA, left branch of the middle colic artery; RV, renal vein; RA, renal artery; K, kidney; LCA, left colic artery. (See color plate.)

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