Anterior abdominal wall nerve and vessel anatomy: clinical implications for gynecologic surgery.
OBJECTIVE
We sought to describe relationships of clinically relevant nerves and vessels of the anterior abdominal wall.


METHODS
The ilioinguinal and iliohypogastric nerves and inferior epigastric vessels were dissected in 11 unembalmed female cadavers. Distances from surface landmarks and common incision sites were recorded. Additional surface measurements were taken in 7 other specimens with and without insufflation.


RESULTS
The ilioinguinal nerve emerged through the internal oblique: mean (range), 2.5 (1.1-5.1) cm medial and 2.4 (0-5.3) cm inferior to the anterior superior iliac spine (ASIS). The iliohypogastric emerged 2.5 (0-4.6) cm medial and 2.0 (0-4.6) cm inferior. Inferior epigastric vessels were 3.7 (2.6-5.5) cm from midline at the level of the ASIS and always lateral to the rectus muscles at a level 2 cm superior to the pubic symphysis.


CONCLUSIONS
Risk of anterior abdominal wall nerve and vessel injury is minimized when lateral trocars are placed superior to the ASISs and >6 cm from midline and low transverse fascial incisions are not extended beyond the lateral borders of the rectus muscles.
Rahn
David D
DD
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Phelan
John N
JN
Roshanravan
Shayzreen M
SM
White
Amanda B
AB
Corton
Marlene M
MM
D034861:Abdominal Wall / Q000098:blood supply* / Q000294:innervation*; D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D019074:Epigastric Arteries / Q000033:anatomy & histology; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007001:Hypogastric Plexus / Q000033:anatomy & histology; D007431:Intraoperative Complications / Q000517:prevention & control; D017568:Rectus Abdominis / Q000098:blood supply / Q000294:innervation