Alignment of gastric bougie 33 4.7 [4.49 - 4.9] Key step Introducqon endostapler from right side 33 3.42 [2.98 - 3.87] 29 2.9 [2.45 - 3.34] Placing and firing first stapler a 33 4.36 [4.1 - 4.63] Key step Introducqon endostapler from le side 33 2.97 [2.5 - 3.44] 28 3.04 [2.57 - 3.5] Firing stapler in cephaled direcqon alongside bougie 33 4.21 [3.86 - 4.56] 28 4.11 [3.77 - 4.45] Key step Changing stapler cartridge depending on qssue thickness 33 4.09 [3.79 - 4.39] 28 4.04 [3.71 - 4.36] Key step Waiqng 15 seconds between closing and firing stapler 33 3.15 [2.78 - 3.52] 28 3.14 [2.63 - 3.66] Checking 15 second duraqon by scrub nurse 33 1.97 [1.58 - 2.36] Excluded Lateral tracqon to avoid leaving excessive posterior stomach qssue 33 4.12 [3.82 - 4.43] 28 4.21 [3.93 - 4.5] Key step Dissecqng angle of His ventral side 33 4.06 [3.7 - 4.43] 28 4.07 [3.77 - 4.37] Key step Dissecqng Belsey’s fat pad b 33 3.12 [2.65 - 3.59] 28 3.43 [2.96 - 3.89] Detaching stomach from le crus with goldfinger 33 2.18 [1.75 - 2.61] Excluded Final stapling sleeve 33 4.7 [4.49 - 4.9] Key step Haemostasis 33 4.67 [4.46 - 4.88] Key step Checking the sleeve and finishing the opera2on Occlusion of sleeve 33 2.88 [2.3 - 3.46] 28 2.57 [1.99 - 3.15] Leak test with insqlling methylene blue dye 33 2.61 [2.07 - 3.14] 28 2.36 [1.81 - 2.91] Leak test with insufflaqng air 33 1.94 [1.51 - 2.36] Excluded Retrieving specimen through enlarged trocar site 33 4.39 [4.06 - 4.72] Key step Placement of a drain 33 1.82 [1.36 - 2.27] Excluded Checking removal of gastric tube 33 3.58 [3.17 - 3.98] 28 3.75 [3.36 - 4.14] Advised Removal of liver retractor 33 4.33 [3.95 - 4.72] 28 4.04 [3.63 - 4.44] Key step Removal of trocars 33 4.58 [4.27 - 4.88] Key step Closure of fascia 33 2.7 [2.22 - 3.17] 27 2.44 [2 - 2.89] Skin closure 33 4 [3.57 - 4.43] 27 3.67 [3.27 - 4.06] Advised Sign out 33 4.27 [3.94 - 4.61] 27 4.11 [3.7 - 4.53] Key step CI = confidence interval, OR = operating room a The distance from the pylorus was not discussed in this survey b Belsey’s fat pad is an eponym of the gastroesophageal junction fat pad 4 71 The crucial steps in gastric bypass and sleeve gastrectomy procedures
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