A video-gastroscope with monitor are placed at the head, to the left of the anesthesia machine and anesthesiologist. All images, Text and descriptions are property of the Online Atlas of Surgery. Reproduction by written permission only. Copies of the origional artwork are available as either slides or prints. Attempting this at the level of the gastroesophageal junction is often hindered by scarring at this location.
Fibrosis can obliterate the usual anatomical planes.
Factors influencing the amount of GE junction scarring include long standing disease, and esophageal interventions like dilation or injection of the lower esophageal sphincter. For these reasons the muscular dissection is initiated about 5 to 7 cm above the gastroesophageal junction. Special circumstances exist in all cases, and judgment is invariably required for optimal port positioning. One pitfall is placing the camera too far from the xiphoid. The dissection will proceed above the diaphragm, requiring the camera to travel a greater distance in the cranial direction than is usually experienced in other abdominal endoscopic procedures.