Lap Nissen trinity narrated

The Coseal Trinity 5mm device functions as both an excellent dissector with tips almost as fine as a Maryland and a vessel sealer.

Trocar placement includes 3 millimeter ports in the epigastrium for retraction and a 3 and 5 millimeter port in the left and right hand respectively for ancillary instruments.

The surgeon stands between the patient's legs with the cameraman on the surgeon's left.

Care is taken not to carry dissection high into the hiatus to avoid increased risk of hiatal hernia.

The anterior vagus nerve must be identified and preserved during retroesophageal dissection.

The gastrohepatic ligament is taken down to expose the right crus and create a safe retroesophageal window.

The Trinity device can seal and divide blood vessels up to 7 millimeters in size.

The Trinity device produces almost no heat spread, which prevents injury to the stomach, spleen, or surrounding organs.

The retroesophageal window is developed to eliminate the risk of injury to the esophagus or the posterior wall of the stomach.

The left crus is slightly cleaned to better allow for crural repair.

A small amount of peritoneum overlying the upper esophagus is taken to allow for proper placement in the wrap.

A 2-0 Ethibond suture on RB1 needle is used for crural repair in patients ranging from 2 kg to 100 kg.

Establishing good length of intraabdominal esophagus is key to developing a good wrap and preventing a slip Nissen.

The wrap should be tension-free and brought around behind the esophagus.

A small anterior bite of the esophagus is taken at the 10 and 11 o'clock position during wrap construction.

The stomach retractor is used to lengthen the esophagus by pulling downward, ensuring the wrap is above the GE junction.

Three stitches are used to complete the wrap.

The wrap is generally under 2 centimeters in length to ensure that an obstructive force is not created.

Great care is taken to make sure that the wrap is loose and there is no twisting of the esophagus.

The patient is started on clear liquids immediately after the procedure and discharged the following morning.