title: Visualization of the epigastric vessels and bladder before laparoscopic trocar placement.
abstract: OBJECTIVE
  Transillumination and laparoscopic visualization are two techniques recommended to minimize the risks of injury to abdominal wall structures during insertion of secondary trocars. This study was designed to determine the effectiveness of these techniques to locate the epigastric vessels and superior bladder margin.
  
  
  METHODS
  Prospective observational.
  
  
  METHODS
  Academic medical centers.
  
  
  METHODS
  One hundred five women undergoing laparoscopy for tubal sterilization, infertility, pelvic masses, or pelvic pain.
  
  
  METHODS
  None.
  
  
  METHODS
  The ability to visualize the superficial and inferior epigastric vessels, and bladder margin; body mass index (BMI; in kilograms per meter squared); and skin color.
  
  
  RESULTS
  Transillumination successfully visualized 64% of superficial epigastric vessels and was less effective both as weight increased (BMI <25 kg/m(2): 86%; BMI = 25-30 kg/m(2): 61%; BMI >30 kg/m(2): 25%) and in dark-skinned women (69%) compared to those with lighter skin (42%). Laparoscopic visualization successfully identified 82% of inferior epigastric vessels and 46% of bladder margins, and was less effective as weight increased.
  
  
  CONCLUSIONS
  Transillumination can successfully locate superficial epigastric vessels, and laparoscopic visualization can locate inferior epigastric vessels and the superior bladder margin in the majority of women undergoing laparoscopy. Transillumination is less effective in dark-skinned women, and both techniques are less effective with increasing body weight.
authors.affiliation: Department of Obstetrics and Gynecology, Wright State University School of Medicine, Dayton, Ohio 45409-2793, USA. william.hurd@wright.edu
authors.forename: William W
authors.initials: WW
authors.lastname: Hurd
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Amesse
authors.forename: Jack S
authors.initials: JS
authors.lastname: Gruber
authors.forename: Gary M
authors.initials: GM
authors.lastname: Horowitz
authors.forename: Grace M
authors.initials: GM
authors.lastname: Cha
authors.forename: Jean A
authors.initials: JA
authors.lastname: Hurteau
mesh_terms: D001835:Body Weight; D019074:Epigastric Arteries / Q000033:anatomy & histology*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D011446:Prospective Studies; D013525:Surgical Instruments / Q000009:adverse effects; D014172:Transillumination / Q000379:methods*; D001743:Urinary Bladder / Q000033:anatomy & histology*