Port placement for foregut surgery*

A Veress needle is placed in the upper abdomen to insufflate the peritoneal cavity. A 5 mm port is placed through the Veress needle tract, and the laparoscope is placed. Additional ports are placed under direct vision. The 5 mm port in the subxiphoid region is used for a laparoscopic liver retractor. Right and left subcostal ports (5 mm) are placed, and two additional ports are placed midway between these subcostal ports and the umbilicus. One of the midabdominal ports is used to pass the surgical stapler (12 mm) and/or special suturing instruments.
The surgeon stands on the patient's right side using the dissector and stapler through the right-sided ports (shown in red). The assistant stands on the patient's left side operating the laparoscope with their left hand through the 5 mm midabdominal port site and provides countertraction for the surgeon through the left subcostal port site (shown in blue). Alternatively, the patient can be placed in a split leg (ie, lithotomy) position, and the surgeon can operate from a position between the legs.