Step 2 Laparoscopic Access

For the "transperitoneal approach," the patient is repositioned into 60-degree flank, with the iliac crest just below the break of the operating table. The patient is supported with a back roll and axillary rolls, and all pressure points are adequately padded. The table is slightly flexed to expand the working space. The patient is secured on to the table with a 3-inch. cloth tape across the greater trochanter of the ipsilateral femur and across the upper chest at the nipple line. Veress needle access is obtained along the parasagittal plane at the midpoint between the umbilicus and the anterior superior iliac spine, at or just above the level of the umbilicus. A 12-mm trocar is placed at this location. Under laparoscopic visualization, a 5-mm trocar is placed along the same parasagittal line, just under the costal margin. Lastly, a second 12-mm trocar is placed between the working ports in the midline or along the ipsilateral pararectal line. On the right side, an additional 5-mm trocar may be necessary to retract the liver.

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