**5. Ports placement and patient's installation on the table**

Patient preparation for LCBDE is the same as the patient positioning for laparoscopic cholecystectomy [59].

The video monitor is placed on the right side of the patient.

The patient is in a supine position on the operative table with abducted legs strapped to the table. The surgeon stands between the patient's legs and the first assistant stands on the surgeon's left side, holding a 30° oblique optic. The second assistant stands on the right side of the surgeon (French position).

After general anesthesia, pneumoperitoneum is created through the umbilicus with a Veress needle usually by closed access technique. Open access is useful if there are adhesions from previous surgery. During the intervention, we maintain the intra-abdominal pressure at 12–13 mmHg. After the creation of pneumoperitoneum, the patient is placed at a semi-Fowler's 15° position and left lateral rotation of the operating table.

We used the 5-hole method for the operation: the laparoscopic observation hole was located through the umbilicus. There are two working ports for the surgeon, a 10-mm trocar placed under the xiphoid process, and a 5-mm trocar was placed 5 cm below the costal margin at the midclavicular line on the right side. Two additional trocars are placed at the right anterior axillary line and the second one just below the xiphoid. The last port is used for the introduction of a bronchoscope for visualization of distal CBD or Dormia basket, balloon catheter, and blunt forceps for stones extraction from CBD.
