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Figure 2. Retracted liver
Figure 3. Release and ligation of the omentum
Figure 4. Insertion of first and second staplers from the 15-mm trocar
After the dissection of the greater curvature, a calibrating bougie (36F) is placed at the stomach and passed
through the pylorus by the anesthesiologist. The first and second linear staplers are placed from the 15-mm
trocar at the right upper quadrant to divide the stomach [Figure 4]. To avoid the narrowing at the incisura
angularis, the first stapler is adjusted parallel to the pylorus. The first fired stapler and traction from the left
trocar is very important to ensure a straight stapler line.
The remaining staplers are fired in cranially along the greater curvature of the stomach [Figure 5]. While
black or green cartridges are applied to the first two firings, blue or purple cartridges are applied to the
remaining part according to the thickness of the stomach. For transection, approximately 5-7 staplers are
necessary to complete the transaction.
