Optimal trocar placement for ergonomic intracorporeal sewing and knotting in laparoscopic hiatal surgery

American Journal of Surgery
Abe FingerhutEmmanuel Leandros

Abstract

Trocar placement presently is mostly empiric. Our goal was to define simple distances from bony landmarks to locate the optimal ergonomic placement of manipulation trocars for access to the lower esophagus and hiatal orifice, for suture placement, and knotting of the gastric fundus and crura. Hypothesizing that the ideal ergonomic principles of a manipulation angle of 60°, an elevation angle (α(e)) of 30° to 60°, and an intracorporeal/extracorporeal length ratio (I/E) of working instruments close to 1:1 are interrelated by simple trigonometric functions, the variations of each of these parameters were calculated in a dependent manner for 2 standard lengths of needle holders: 48.5 cm and 58.5 cm. Trocar placement can be calculated easily according to simple formulas dependent on the α(e), the distance from the sternoxiphoid junction to the median of the intertrocar span (d) and the vertical distance from the stenoxiphoid junction to the average distance between the apex of the hiatal orifice and the anterior aspect of the esophagus (XH'): when the α(e) is 30°: d is XH' √2 and when α(e) is 45°, d is XH'/√2. Likewise, when α(e) is 30° the intertrocar span (LR) is 2XH', half on either side of the optical axis (d), and when α(e) is ...Continue Reading

References

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Citations

Mar 13, 2014·Journal of Laparoendoscopic & Advanced Surgical Techniques. Part a·Daniel Lorias EspinozaJosé Antonio Gutiérrez Gnecchi
Sep 3, 2013·Minimally Invasive Therapy & Allied Technologies : MITAT : Official Journal of the Society for Minimally Invasive Therapy·Dongjuan XiaoRichard H M Goossens
May 7, 2019·World Journal of Gastrointestinal Surgery·Konstantinos PerivoliotisIoannis Baloyiannis
Jul 8, 2021·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·Shing Wai WongPhilip Crowe

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