TASK / STEP 1 2 3 4 5 N/A Create enterotomies in BP and Roux limbs Poor relation between grasper and energy source; excessively large or small; penetration of posterior bowel wall Appropriate size enterotomy not placed in antimesenteric location Appropriately sized and placed enterotomies; no extra movements. Good relation of grasper and energy source Stapling Insert the limbs of linear cutting stapler into the enterotomies in Roux and BPLs Unclear of how to insert the staple device. Drives staple with jaws blindly into BP and Roux limb Inserts the stapler hesitation and lacks appreciation of the ideal angle for insertion Inserts staple jaws with ease; controlled manner; correct angle Ensure both limbs are symmetrical and stapler on antimesenteric border Does not ensure limb symmetry and antimesenteric position before closure of jaws Limbs either nonsymmetrical or not on antimesenteric border before closure of jaws Correctly ensures symmetry and anti-mesenteric position before closure of the jaws Fire stapler Uncontrolled fire with excessive pull on the bowel and widening of enterotomies Controlled fire; some slippage of bowel from jaws Smooth, controlled fire; no widening of enterotomies Close the created enterotomy with a simple running suture or a linear cutting stapler Poorly positioned stitch or stapler. Blindly placed sutures; traumatic use of needle drivers; skiving and poor control of needle; too much or too little tension; poor quality knot Adequate stitch or stapler position. Adequate closure of enterotomy. Sutures placed at varying distances apart; gathering of bowel edges; additional reinforcement sutures required; stitch pulled out clumsily Correct stitch or stapler position. Adequate size bites placed uniform distance apart; perpendicular to seromuscular layer; appropriate tension; adequate surgical knot; needle retrieved safely Dissection of the phreno-esophageal ligament (angle of His) Place patient in steep reverse Trendelenburg Patient not repositioned Patient repositioned after prompting Patient repositioned without delay 5 101 A new procedure-based assessment in gastric bypass surgery
RkJQdWJsaXNoZXIy MTk4NDMw