Mayo stand and back table instruments for Laparoscopic Nissen Fundoplication surgery setup

Clamping & Occluding

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  Curved Hemostat

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  Kocher Forceps

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  Allis Forceps

Cutting & Dissecting

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  L Hook Cautery

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  #3 Knife Handle

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  Laparoscopic Metz Scissor

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  Straight Mayo Scissor

Grasping & Holding

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  Standard Laparoscopic Grasper

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  Laparoscopic Babcock Forceps

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  Laparoscopic Grasping Forceps

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  Laparoscopic Allis Grasper

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  Fundus Laparoscopic Grasping Forceps

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  Adson Forceps

Retracting & Exposing

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  Fan Retractor

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  Hasson S Retractor

Suctioning

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  Suction Irrigator

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  Yankauer Suction

Suturing & Stapling

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  Appel Laparoscopic Knot Pusher

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  Mayo-Hegar Needle Holder

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  Bariatric and Laparoscopic Needle Holder

What to expect during Laparoscopic Nissen Fundoplication

The patient will be positioned in lithotomy with the head tilted up. The doctor usually stands in between the patient’s legs, whoever is holding the camera will usually be on the right, with the surgical technologist on the left.

Trocar incision sites will be made using the #3 knife handle with an 11 blade loaded onto it. Usually around 5 trocars are used, and the size will depend on the surgeon’s preference. The surgeon will insert some laparoscopic graspers, and look around to see what they are dealing with. A fan retractor will be used to retract the liver.

The esophageal hiatus will be viewed, and a babcock will be placed on the fat pad and be retracted with tension. A cautery hook and a grasper will be used on the ligament, while avoiding the nerves and hepatic artery. This will make a “window”.

They will then do blunt dissection with their graspers around the esophagus. Once all of the major body landmarks have been found and dissected, then the hiatus can be closed, usually with proline suture. A bougie may be placed in the esophagus to make sure they are suturing in the right place. A harmonic may be used on vessels. The stomach will then be freed by ligating the gastric vessels.

Closure can then begin after hemostasis is achieved.