title: Where is the aorta? Is it worth palpating the aorta prior to laparoscopy?
abstract: BACKGROUND
  Injury to major retroperitoneal vessels is the most catastrophic complication of laparoscopy. Knowledge of the site of the aortic bifurcation prior to inserting the umbilical port would be expected to reduce the risk of this type of injury. The aim of the study is to determine the feasibility of identifying the aortic bifurcation by palpation prior to the operation.
  
  
  METHODS
  We studied 100 patients undergoing laparoscopic surgery or laparotomy. After prepping and draping, the operating surgeon felt for the aortic bifurcation to determine its position in relation to the umbilicus. We then related our findings to the height, weight, and body mass index of the patient.
  
  
  RESULTS
  The aorta could not be palpated in 15% of cases, including almost 2/3 of women who were obese (body mass index >30). In the remaining 85% cases, where the aorta was palpable, the bifurcation was above the level of the umbilicus in 30 (35%) cases, at the umbilicus in 45 (53%) cases, and below in 10 (12%) cases. We did not find any significant effect of body mass index, height, or weight on the level of the aortic bifurcation by palpation. No vascular injury occurred in the laparoscopic cases during the study.
  
  
  CONCLUSIONS
  The aortic bifurcation is palpable in the majority of women undergoing surgery, including 93% of those with a low or normal body mass index who are at higher risk of vascular injury. We recommend the routine palpation for the aortic bifurcation as a simple means to reduce the risk of injury to a major retroperitoneal vessel.
authors.affiliation: Minimally Invasive Therapy Unit & Endoscopy Training Centre, University Department of Obstetrics and Gynaecology, Royal Free Hospital, Pond Street, Hampstead, London, NW3 2QG, England.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Polyzos
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Papadopoulos
authors.forename: Lynne
authors.initials: L
authors.lastname: Chapman
authors.forename: Panos
authors.initials: P
authors.lastname: Papalampros
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Varela
authors.forename: Pietro
authors.initials: P
authors.lastname: Gambadauro
authors.forename: Adam
authors.initials: A
authors.lastname: Magos
mesh_terms: D000328:Adult; D001011:Aorta / Q000033:anatomy & histology*; D001808:Blood Vessels / Q000293:injuries; D001827:Body Height; D015992:Body Mass Index; D001835:Body Weight; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D009765:Obesity / Q000473:pathology; D010173:Palpation; D011446:Prospective Studies; D012187:Retroperitoneal Space / Q000098:blood supply*