- Following the induction of general anesthesia the patient is rotated into a right lateral decubitus position with the patient’s lowest ribs positioned at the table flex point.
- The table is flexed and the kidney rest is elevated to better expose the left flank.
- An axillary roll is placed and the arms bent 90 degrees at the elbow.
- The patient is secured in this position with tape or a bean bag.
- Prior to rotating the patient into decubitus position, a Foley catheter, OG (oral-gastric) tube, and venous compression boots are placed.
- The surgeon and assistant stand on the right side of the table. The scrub nurse is positioned on the left side. Monitors are present on both sides.
- Entry is gained 1 cm inferior to the left costal margin, just to the left of the xyphoid. This can be obtained via optical entry with a trocar, such as ENDOPATH XCEL™ Trocars with Optiview Technology or direct cutdown (Hassan technique).
- Following insufflation and insertion of a 30-degree laparoscope two 12 mm ports are placed in the left abdomen, and a 5mm port in the left flank.