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Laparoscopic Roux-en-Y Gastric Bypass Images

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Laparoscopic port placement.
VID 126, frame 1

rouG4002

 

Port 4 is used for liver retractor.
VID 126, frame 1

rouG4003

 

Gastrohepatic omentum is divided toward the esophageal hiatus.
VID 126, frame 2

rouG4005

 

Fundus of stomach is freed from diaphragmatic attachments.
VID 126, frame 3

rouG4007

 

16 Fr. balloon tipped catheter introduced and inflated with 15cc of air.
VID 126, frame 4

rouG4009

 

Balloon pulled back to the esophago-gastric junction.
VID 126, frame 4

rouG4010

 

Small gastrotomy on the lesser curve side of the balloon is made with a 3mm spatula-tipped monopolar cautery.
VID 126, frame 5

rouG4012

 

Balloon may be ruptured.
VID 126, frame 5

rouG4013

 

A 2cm gastrotomy is made 4cm distal to the small gastrotomy using cautery scissors.
VID 126, frame 6

rouG4015

 

Gastrotomy shown.
VID 126, frame 6

rouG4016

 

Cholangiogram catheter with a 3-0 prolene suture tied in a loop proximal to the balloon is introduced into the small gastrotomy.
VID 126, frame 7

rouG4017

 

Balloon is inflated after insertion.
VID 126, frame 8

rouG4018

 

Inflated balloon.
VID 126, frame 8

rouG4019

 

Catheter tip graspedů
VID 126, frame 8

rouG4020

 

...and pulled out through the large gastrotomy.
VID 126, frame 8

rouG4021

 

Balloon extracted.
VID 126, frame 8

rouG4022

 

21 mm endoscopic circular stapler anvil introduced into abdomen, with loop of 2-0 silk tied through tip of anvil stem prior to introduction.
VID 126, frame 9

rouG4024

 

Anvil loop is passed through catheter loop, then slipped around anvil to lock the two together.
VID 126, frame 9

rouG4026

 

Cholangiogram catheter is withdrawn...
VID 126, frame 10

rouG4027

 

...to pull anvil through the larger gastrotomy...
VID 126, frame 10

rouG4028

 

...and then pull the stem out the small gastrotomy.
VID 126, frame 10

rouG4029

 

Stem secured in place...
VID 126, frame 10

rouG4030

 

...with 3-0 silk purse string suture.
VID 126, frame 10

rouG4031

 

Large gastrotomy closed with endoscopic linear cutter.
VID 126, frame 11

rouG4032

 

Starting on the lesser curve just caudal to the anvil...
VID 126, frame 12

rouG4033

 

...the space behind the stomach is opened bluntly.
VID 126, frame 12

rouG4034

 

Staple-line reinforcement material is used on stapler during division of the stomach to protect against bleeding and leakage.
VID 126, frame 13

rouG4035

 

Second firing of endoscopic linear cutter is directed from the end of the first reinforced staple line toward the cardia just lateral to the angle of His.
VID 126, frame 13

rouG4036

 

Gastro-colic omentum opened along greater curve of stomach.
VID 126, frame 14

rouG4038

 

Opening made in an avascular part of the transverse mesocolon.
VID 126, frame 15

rouG4040

 

Transverse mesocolon opened.
VID 126, frame 15

rouG4041

 

Penrose drain placed through opening in transverse mesocolon.
VID 126, frame 16

rouG4042

 

Greater omentum lifted to identify the jejunum at the ligament of Treitz.
VID 126, frame 17

rouG4043

 

Bowel is followed a distance of 15-20cm and divided.
VID 126, frame 17

rouG4044

 

Bowel division complete.
VID 126, frame 17

rouG4045

 

End of Penrose drain sutured to distal end of divided bowel.
VID 126, frame 18

rouG4046

 

Side-to-side stapled anastomosis created between proximal limb and side of distal limb.
VID 126, frame 19

rouG4047

 

Penrose drain pulled from above the transverse mesocolon, drawing free end of jejunum through in a retrocolic, ante-gastric position.
VID 126, frame 20

rouG4048

 

End of bypass limb directed to patient's left, and a large enterotomy created near end of limb with cautery scissors.
VID 126, frame 21

rouG4050

 

Endoscopic circular stapler introduced into the enterotomy and advanced 4-6 cm.
VID 126, frame 22

rouG4051

 

Male end of circular stapler brought out through antemesenteric side of jejunum...
VID 126, frame 23

rouG4052

 

...and stem insert is removed from anvil.
VID 126, frame 23

rouG4053

 

Male and female ends...
VID 126, frame 24

rouG4055

 

...are joined...
VID 126, frame 24

rouG4056

 

...and stapler is closed slowly...
VID 126, frame 24

rouG4057

 

...and stapler is closed slowly...
VID 126, frame 24

rouG4058

 

Stapler removed by gently rotating and tissue donuts inspected for completeness.
VID 126, frame 25

rouG4059

 

Endoscopic linear cutter used to remove free end of jejunum, including the enterotomy.
VID 126, frame 26

rouG4060

 

This page was last modified on 1/13/2000.
 

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