Nissen Fundoplication

Anesthetized patients are prepared and draped in the usual fashion, and the abdominal cavity is insufflated with carbon dioxide gas. Three incision ports are made as shown in Figure 66-5 . The first port is for the telescope trocar, which is placed 15 cm below the xiphoid process and slightly to the left of midline. The robot arms are then inserted through trocars located 10 cm on either side of the telescope while under laparoscopic vision. Other auxiliary ports can be placed at any time during the operation. The side cart is wheeled and locked into place in anticipation of engaging the instruments within their respective trocars. The system can be activated to manipulate the robotic arms under the surgeon's control. When a surgeon requires instruments to be changed, the manipulation is stopped, and the assistant surgeon at the table is asked to disengage and replace the instrument.