title: Variance in abdominal wall anatomy and port placement in women undergoing robotic gynecologic surgery.
abstract: OBJECTIVE
  To estimate whether variability in the size and ratios of the lower and upper abdomen exist in women undergoing robotic gynecologic surgery and whether demographic variables are significantly associated, and to determine the association between abdominal wall dimensions and supraumbilical robotic port placement.
  
  
  METHODS
  Prospective cohort study (Canadian Task Force classification II-2).
  
  
  METHODS
  University teaching hospital.
  
  
  METHODS
  Seventy-eight women undergoing robotic surgery between May 2008 and March 2009.
  
  
  METHODS
  Measurements from the symphysis pubis to the umbilicus (lower abdomen), umbilicus to the xyphoid process (upper abdomen), and distance between the anterior superior iliac crests were obtained at surgery. A multiple linear regression model was created to determine the relationships between abdominal wall measurements, demographic variables, and need for supraumbilical robotic port placement.
  
  
  RESULTS
  Fifty-six white and 22 black women were enrolled. Mean lower abdominal length was significantly affected by body mass index (BMI) (p <.001) and race (p = .006), with white women having longer measurements (17.1 cm vs 15 cm). Mean lower abdominal width was independent of age (p = .95) or race (p = .98), but was significantly correlated with BMI (p <.001). Mean upper abdominal length correlated with BMI (p <.001) and age (p = .03) but not race (p = .13). Ratios of bottom to top were significantly affected by race (p = .002) and age (p = .008) but not BMI (p = .07). Adjustments to port placement above the umbilicus were made in 44 of the 74 women (59.5%). Those who required supraumbilical port placement had a significantly shorter mean (SD) distance between the symphysis pubis and the umbilicus (14.99 [1.36] vs 18.55 [2.21]; p <.001).
  
  
  CONCLUSIONS
  Significant variability in abdominal wall anatomy exists in women undergoing robotic gynecologic surgery, and the need for supraumbilical robotic port placement is common.
authors.affiliation: Department of Obstetrics and Gynecology, Virginia Commonwealth University Medical Center, Richmond, VA 23298, USA. cmatthews2@mcvh-vcu.edu
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Matthews
authors.forename: Christine M
authors.initials: CM
authors.lastname: Schubert
authors.forename: Ashley P
authors.initials: AP
authors.lastname: Woodward
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Gill
mesh_terms: D034861:Abdominal Wall / Q000033:anatomy & histology* / Q000601:surgery*; D000328:Adult; D001741:Black or African American; D000368:Aged; D015992:Body Mass Index; D001837:Body Weights and Measures; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006785:Hospitals, University; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D012371:Robotics; D014472:Umbilicus / Q000033:anatomy & histology*; D044465:White People