Atlas of Laparoscopic Surgery by Theodore N. Pappas, Lewis B. Schwartz, Steve Eubanks (auth.)

By Theodore N. Pappas, Lewis B. Schwartz, Steve Eubanks (auth.)

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Care IS taken to aeeurately disbnguish the eros from the esophagus. Movlng the nasogastne tube In the esophagus whlle the gastroesophageal junetlon IS vlewed helps to define the anatomy. FIGURE 2-20. Wrth the esophagus retracted to the patlent's nght the left diaphragmatle eros IS dissected. and the spaee between thlS side of the esophagus and erora IS opened bluntly. Wlth the esophagus retracted upward. the retroesophageal spaee IS dlssected under direct VISion. Care IS taken not to enter the pleural spaee.

Beaumont introduced a variety of substances through the ftstula and documented some basic properties of gastric physiology. The first to propose creation of a gastrostomy as a therapeutic procedure was Egeberg, a Norwegian, who thought feeding via gastrostomy would prolong the survival of patients with esophageal carcinoma [1]. Although Egeberg considered a gastrostomy, there is no record of him actually performing one. The frrst to perform a surgical gastrostomy was Sedillot [2] of Strasbourg, placing three gastrostomies over a 9-year period.

This set-up aJlows the surgeon to use both hands simultaneously. I ' -,I IO-mm trocar IO-mm trocar with camera and insufflation Procedure FIGURE 3-10. The intemaJ anatomy of the hlatal area IS shown. A fan retractor is used to hold the left lobe of the liver away from the gastroesophageaJ Juncbon. The asslstant may use an endoscopic Babcock to pull the stomach Inferiorly. FIGURE 3-11. Exposure of the hiatus. Endoscoplc SCISSOrs or a small blunt grasper with elec· trocautery IS used by the surgeon to divlde the lesser omentum.

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