This illlustration demonstrates the view as seen from the 10 mm torcar at the umbilicus. The fan retractor elevates the left lobe of the liver. The hepatogastric ligament is sharply dissected for the mobilization of the gastroesophageal junction. The hepatogastric ligament is opened. The right crus of the diaphragm is then mobilized from the gastroesophageal junction.
Care is taken toaccurately distinguish the crus from the esophagus.
Moving the nasogastric tube in the esophagus while the gastroesophageal junction is viewed helps to define the anatomy. With the esophagus retracted to the patient's right, the left diaphragmaticcrus is dissected, and the space between this side of the esophagus and crura is opened bluntly. With the esophagus retracted upward, the retroesophageal space is dissected under direct vision. Care is taken not to enter the pleural space. An endoscopic Babcock clamp if placed from the most lateral right trocar and is passed behind the gastroesophageal junction.