When the draping is complete, the surgeon and camera operator take position on the patient's right side, while the assistant and scrub tech are on the opposite side. To initiate the operation, the xiphoid is identified by palpation, and 15 cm caudad to this and 3 cm to the left of the midline a 1-cm transverse skin incision is made. An optical, bladeless 10-mm trocar (trocar #1) is advanced under vision with a zero degree laparoscope into the abdomen. After insufflation, a 10-mm 45° scope is used, instead of the straight laparoscope, for the operation. Working ports are introduced, as shown in Figures 22–1 and 22–2. A 12-mm trocar (trocar #2) is placed in the left anterior axillary line at the same level as the camera port. A 5-mm port (trocar #3) is then placed at the midpoint of the line between the xiphoid and trocar #2. The surgeon then places the right-sided working ports. The first is a 12-mm port, which is positioned 7 cm caudal and 4 cm to the right of the xiphoid (trocar #4). A 5-mm port (trocar #5) is placed 5 cm inferior to trocar #4, just to the right of the midline. Occasionally, liver enlargement requires that some or all of the working ports be shifted caudally.