A small skin incision is made well above the navel in the midline. After inserting the Veress needle and verifying the correct position, the pneumoperitoneum is established.
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Skin incision
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Trocar positioning
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Traction of the stomach and incision of the lesser omentum
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Preparation of the diaphragmatic crura with entry into the mediastinum
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Preparation of the lower esophagus
One now proceeds far into the lower mediastinum and circumferentially mobilizes the lower esophagus from its adhesions. In doing so, the posterior vagus nerve is clearly identified and remains with the esophageal musculature. The esophagus is mobilized from the mediastinum to the extent that the area of the lower esophageal sphincter is tension-free in the abdominal cavity.
Mobilization of the gastric fundus
The gastrosplenic ligament and the short gastric vessels are transected at the level of the splenic
The gastrosplenic ligament and the short gastric vessels are transected at the level of the splenic
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