Laparoscopic Nissen Fundoplication

1. Introduction

2. Access and Placement of Ports

1. Insert Veress Needle to Insufflate Abdominal Cavity
2. Insert Supraumbilical Trocar and Sleeve
3. Insert Dissecting Port Trocar and Sleeve
4. Insert Liver Retractor
5. Insert Babcock Port Trocar and Sleeve
6. Insert Assisting Port Trocar and Sleeve

3. Mobilization of Esophagus

1. Cut Gastrohepatic Ligament
2. Dissect Esophagus from Right and Left Crus
3. Dissect Fundus of Stomach Towards Splenic Bed
4. Insert Penrose to Wrap Around Esophagus
5. Dissect Esophagus from Posterior Hiatus
6. Repair the Hiatus
7. Perform Shoeshine Maneuver

4. Fundoplication

1. Grasp Left and Right Parts of Fundoplication
2. Suture the Fundoplication

5. Closure

1. Remove Liver Retractor
2. Remove Trocars and Close Port Sites

6. Post-op Remarks