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Herbella et al. Mini-invasive Surg 2019;3:22 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2019.19

Opinion Open Access

How I teach it - a didactic approach to laparoscopic
surgery at the esophagogastric junction

Fernando A. M. Herbella, Rafael C. Katayama

Department of Surgery, Federal University of Sao Paulo, Sao Paulo, SP 04037-003, Brazil.
Correspondence to: Dr. Fernando A. M. Herbella, Department of Surgery, Escola Paulista de Medicina, Federal University of Sao
Paulo, Rua Diogo de Faria 1087 cj 301, Sao Paulo, SP 04037-003, Brazil. herbella.dcir@epm.br

How to cite this article: Herbella FAM, Katayama RC. How I teach it - a didactic approach to laparoscopic surgery at the
esophagogastric junction. Mini-invasive Surg 2019;3:22. http://dx.doi.org/10.20517/2574-1225.2019.19

Received: 1 Jul 2019 Accepted: 12 Jul 2019 Published: 23 Jul 2019
Science Editor: Giulio Belli Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract

We present an alternative didactic approach to the esophagogastric junction through an active liver retraction with a
laparoscopic palpator. We believe this didactic approach is not necessarily carried by a well-trained team. However,
it is a minor modification of the standard operation that has advantages on surgical training in academic centers.

Keywords: Laparoscopy, stomach, esophagus, esophagogastric junction

INTRODUCTION
Laparoscopic surgery of the esophagogastric junction (EGJ) is a common procedure for a great number
[1]
[2]
of antireflux operations had already been performed . In addition, the surgical treatment of achalasia ,
[4]
[3]
esophageal neoplasms and certain modifications of bariatric operations are included in the laparoscopic
procedures of the EGJ as well. The classical disposition of the ports for laparoscopic surgery of the EGJ
comprises 5 ports. Liver retraction is usually accomplished through the use of dedicate retractors inserted
in the right flank and the retractor is frequently kept static. Alternatively, liver retraction may be obtained
[5]
[6]
through a port in the epigastrium with the aid of a simple stick (palpator) or a Nathanson retractor .
We present an alternative didactic approach to the EGJ through an active liver retraction with a
laparoscopic palpator.

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
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