General anesthesia is necessary for this operation. Each patient receives a single dose of broad-spectrum antibiotic. Sequential compression devices are placed to decrease the risk of deep venous thrombosis. A Foley catheter is used to decompress the bladder and monitor urine output during the operation.
We place the patient in low lithotomy position, which allows the surgeon to stand between the patient's legs during the procedure. To secure the patient in steep reverse Trendelenburg position, a seat is fashioned using a beanbag. The monitor is placed over the patient's head so it can be viewed by the whole operating team. An additional monitor is used to show the anesthesiologist the operative field as he or she is manipulating the esophageal bougie during the operation. The assistant stands on the patient's left side. A self-retaining retractor is secured to the right side of the bed to hold the liver retractor, minimizing the need for a second assistant.
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