Finishing the operation Removal of liver retractor Removal of trocars Skin closure Sign out Key steps laparoscopic sleeve gastrectomy Operative set up Checking of instruments Positioning OR team Positioning monitors Positioning patient Time-out procedure Checking of antibiotic prophylaxis Disinfection, sterile exposure Checking introduction gastric bougie Starting of laparoscopy Introduction optical trocar Introduction of additional trocars under laparoscopic sight Introduction of liver retractor Exposure of operative field Checking presence of hiatus hernia Reduction of hiatus hernia Mobilization of the greater curvature Opening lesser sac at greater curvature Identification pylorus and starting point sleeve Detaching omentum from stomach at greater curvature's full length Ligating short gastric vessels Detaching posterior attachments stomach Stapling the sleeve Alignment of gastric bougie Placing and firing first stapler Firing stapler in cephaled direction alongside bougie Changing stapler cartridge depending on tissue thickness Lateral traction to avoid leaving excessive posterior stomach tissue Dissecting angle of His ventral side Final stapling sleeve Haemostasis Finishing the sleeve Retrieving specimen through enlarged trocar site Finishing the operation Checking removal of gastric tube Removal of liver retractor Removal of trocars Skin closure Sign out Advised steps are printed in italic 4 73 The crucial steps in gastric bypass and sleeve gastrectomy procedures
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