A patient with a BMI of 36 and comorbidities including hypertension and reflux went through pre-operative nutrition and behavioral health screening in preparation for a laparoscopic roux-en-y gastric bypass. Part of her preparation included exercise physiology and attendance of support groups. She underwent a bowel prep and a 2 week liquid diet prior to the operation. A Foley catheter was placed and she was given heparin prior to induction. She has SCDs as well. The patient has a foot board and is securely fastened to the bed with tape and straps. The first port is a 5mm optically guided port at the left midclavicular line. This is the main working port of the first assistant.
The main right hand operating port is 12mm and approximately a hands breadth from the umbilicus, parallel to the camera port. The main left hand port is a 5mm that is at least a hands breadth from right hand port and is triangulated to the hiatus. An additional working port for the first assistant is placed along the left costal margin as lateral as possible. The primary surgeon stands to the right of the patient and the first assist is on the left. The camera operator may stand on either side.
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