What is the recommended setup for examining the small bowel during laparoscopy?

• A. Two monitors, one at head and one at feet; ports all on left; systematic examination from one end to the next; use atraumatic graspers; handle mesenteric fat rather than bowel wall; start at ileocecal valve for SBO
• B. One monitor; ports on right; begin at duodenum
• C. No graspers; palpate only
• D. Single port approach

Answer: (B)

Systematic, efficient evaluation of the small bowel during laparoscopy relies on a simple setup and a proximal-to-distal survey. Using a single monitor keeps the setup straightforward and is common in diagnostic laparoscopy for small-bowel work. Placing the ports on the right side gives ergonomic access to the duodenum and proximal small bowel, allowing comfortable instrument triangulation and camera control.

Starting the inspection at the duodenum provides a solid anatomic anchor and sets up a natural path to follow the bowel distally. From there you can trace the jejunum and ileum along the mesentery, checking for causes of obstruction, inflammatory disease, ischemia, or masses in a systematic order. This approach helps ensure you don’t miss subtle findings and makes orientation easier within the intraperitoneal space during the survey.

Maintain gentle, atraumatic handling with appropriate graspers, keep the bowel moist and well-visualized, and perform the inspection in a steady, organized fashion from proximal to distal.