Visualization of the epigastric vessels and bladder before laparoscopic trocar placement.
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.
Hurd
William W
WW
Department of Obstetrics and Gynecology, Wright State University School of Medicine, Dayton, Ohio 45409-2793, USA. william.hurd@wright.edu
Amesse
Lawrence S
LS
Gruber
Jack S
JS
Horowitz
Gary M
GM
Cha
Grace M
GM
Hurteau
Jean A
JA
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*