Creating a safe pneumo-peritoneum
in a morbidly obese patient is simple. The same safety rules apply. A
Standard or Long (120cm) is used to create the pneumo-peritoneum. We
favor the sub-umbilical position.
The trocars are inserted as shown. The
intra-abdominal cavity is explored.
The surgeon will check the omentum is free of
adhesions ( pelvis). The omentum is then retracted toward the upper
portion of the intra-abdominal cavity as the operating table is tilted
in Trendelenbourg Position (Head down).
A Mediflex® 5 mm Retractor is inserted and
locked in place (using the MEDFLEX® Retractor or the
ENDORETRACT®) retracting the omentum cephalad while simultaneously
exposing the ligament of Trietz.