Positioning of the patient depends primarily on the procedure to be performed.

In the supine
position the arms can be tucked snugly at the sides or rest on specially designed sleds. In the
Trendelenburg or lateral position, tape and security belts applied across the chest and thighs
provide safe and stable positioning of the patient. In the lateral position, all bony prominences
in contact with the table must be carefully padded; likewise, the point of contact between any
of the positioning straps and the hip or shoulder should be padded. In the lateral position, the
bottom leg is flexed approximately 45 degrees while the upper leg is kept straight; pillows are
placed between the legs as a cushion and also to elevate the upper leg so that it lies level with
the flank, thereby obviating any undue stretch on the sciatic nerve. Pads should be placed
between the table and the knee and ankle of the lower leg because these are high pressure
areas. In the lateral decubitus position an axillary roll should be used. Application of an active
warming system may prevent hypothermia, should a lengthy laparoscopic procedure be
anticipated. A host of new advances in padding and table-mounted accessories are now
available, but none has been conclusively demonstrated to significantly reduce pressure on
the patients flank in the lateral position. Selection of port sites determines access to the
operative field. The general scheme is to surround the site with the necessary number of
instruments placed idely enough apart that they do not sword fight in the abdomen and with
the laparoscope situated so that a good visual angle can be attained. There are a variety of
ports available, with the standard sizes being 5, 10, and 12 mm. Needlescopic ports (3 mm)
as well as extra-wide ports (18 and 30 mm) are available for specialized use. Ports can be
completely disposable, completely reusable, or re-posable ports, which contain both
reusable and disposable components. Many disposable ports have sharp tips that are shielded
to prevent viscus injury Reusable ports most commonly have a metal trocar with a metal or
plastic cannula (or both). Finally, there are the re-posable ports. The cannulae are reusable
and the trocars, blades, and diaphragms are mixed disposable and reusable.