Surgeon on the Left Side, an Alternative Position that May Improve Exposure in Gastric Sleeve?

The position of the patient with the surgeon between the legs "the French position" remains the most commonly used. We describe an alternative technique for sleeve gastrectomy using three trocars (one of 12 mm, 2-4 cm from the umbilicus, and two of 5 mm), and the surgeon positioned to the left side of the patient, in order to facilitate dissection and exposure in sleeve gastrectomy.

Between January 2015 and December 2017, this technique was already used in 50 sleeve gastrectomies.

In one case, a 5-mm trocar was added in the right upper quadrant for liver retractor. The decubitus position without the legs being spread is way easier and more tolerated by the extremely obese patients or those with joint pathologies. However, the supine position has disadvantages for intubation and respiration during the procedure.

The operation is not really different regardless of where the surgeon stands, but we think that the positon on the left side can give a better exposure of the gastric fundus.