The location of abdominal wall blood vessels in relationship to abdominal landmarks apparent at laparoscopy.
OBJECTIVE
Our purpose was to evaluate the location of the major blood vessels of the abdominal wall relative to landmarks apparent at laparoscopy.


METHODS
Abdominal computed tomographic images of 21 reproductive-aged women at an academic center were retrospectively reviewed to determine the location of the inferior epigastric, superficial epigastric, and superficial circumflex iliac arteries and the lateral rectus muscle margins in relation to the symphysis pubis, the umbilicus, and the abdominal midline. These locations were correlated with each other and with body mass index using Pearson's correlation coefficient.


RESULTS
Above the symphysis the inferior and superficial epigastric arteries were 5.6 +/- 1.0 cm (mean +/- SD) and 5.5 +/- 2.0 cm from the midline, respectively. Although the location of these two vessels correlated (r = 0.6, p = 0.02), the mean difference in their location was 1.4 +/- 1.1 cm. Near the level of the umbilicus the superficial epigastric and circumflex iliac arteries and the lateral rectus muscle margin were 4.6 +/- 1.4 cm, 10.7 +/- 1.7 cm, and 7.6 +/- 1.5 from the midline, respectively. Only the lateral rectus muscle margin correlated with body mass index (r = 0.65, p = 0.004).


CONCLUSIONS
When laparoscopic landmarks are not visible to guide placement, lateral trocars should be placed approximately 8 cm from the midline and at least 5 cm above the symphysis to minimize the risk of vessel injury.
Hurd
W W
WW
Department of Obstetrics and Gynecology, University of Michigan Medical Center, Ann Arbor.
Bude
R O
RO
DeLancey
J O
JO
Newman
J S
JS
D000009:Abdominal Muscles / Q000098:blood supply* / Q000000981:diagnostic imaging; D000293:Adolescent; D000328:Adult; D001808:Blood Vessels / Q000033:anatomy & histology; D015992:Body Mass Index; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000033:anatomy & histology; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D011631:Pubic Symphysis / Q000033:anatomy & histology; D017568:Rectus Abdominis / Q000033:anatomy & histology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed