TASK / STEP 1 2 3 4 5 N/A Develop a posterior tunnel towards the angle of His Dissection in incorrect plane unnecessary force; bleeding requiring suction Dissection in correct plane;occasional tissue damage; bleeding not requiring suction Dissection in correct plane; careful handling of tissues, minimal tissue damage, bleeding Clean up posterior attachments (if present and prevent introduction of stapler) between the stomach and pancreas in the lesser sac Posterior attachments not cleared; excessive force, tissue trauma, bleeding requiring suction Majority of attachments cleared up; moderate tissue trauma, bleeding not requiring suction Attachments cleared; careful handling of tissues; minimal tissue trauma, bleeding Introduce and apply another linear cutting stapler to the stomach Stapler applied in an incorrect orientation; serosal damage to stomach Stapler applied correctly; multiple repositioning attempts Stapler applied correctly; no repositioning required; no trauma to stomach wall Fire stapler Uncontrolled fire with excessive pull on the stomach Controlled fire; some slippage of stomach between jaws Smooth, controlled fire Confirm complete transection of stomach Not confirmed Confirmed briefly without adequate visualization Methodical confirmation of complete transection Positioning of the Roux limb: Antecolic, antegastric If required, divide omentum to the transverse colon with an energy source Not performed when necessary; excessive tissue trauma; bleeding; injury to colon Performed appropriately; moderate tissue trauma; bleeding Performed correctly; minimal tissue trauma; bleeding Bring up Roux limb antecolic and antegastric Incorrect position; excessive tension or twisting of limb Correct positioning; repositioning required; limb slips Correct positioning; minimal tension or twisting Creation of the GJ anastomosis: Linear stapler technique 5 103 A new procedure-based assessment in gastric bypass surgery
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