Optimal port placement during laparoscopic radical prostatectomy.
BACKGROUND
Placement of anterior abdominal wall trocars during laparoscopic radical prostatectomy (LRP) carries the risk of inadvertent injury to the inferior epigastric artery (IEA) and crossover confliction between midline and lateral ports.  We described and evaluated a new measured port placement approach.


METHODS
The intervention group included patients who underwent LRP with a specifically measured five port approach.  The medial 10 mm ports were placed 5 cm from the patient's midline at a level mid-way between the anterior superior iliac spine (ASIS) and the umbilicus.  The control group had five ports placed at the surgeon's discretion.  We prospectively compared intraoperative blood loss, need for port repositioning, and incidence of adverse surgical events.


RESULTS
In the interventional cohort patients (n = 112) the course of the IEA was found to be lateral to the medial 10 mm port in all cases.  There were no adverse surgical outcomes in this group.  In the control group patients (n = 97), three demonstrated IEA injuries (p <0.01) and three required port repositioning (p < 0.01).  The mean blood loss reported between groups was not significant (p = 0.70).


CONCLUSIONS
Our specifically measured port placement approach predictably allowed for the placement of the trocar medial to the IEA.  This minimized the risk of injury to the IEA, allowed for adequate instrument manipulation and minimized the need to reposition ports.
Department of Surgery, Division of Urology, McMaster University, Hamilton, Ontario, Canada.
Ashis
A
Chawla
Adnan
A
Qureshi
Aziz
A
Alamri
Edward D
ED
Matsumoto
D000328:Adult; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D006801:Humans; D007432:Intraoperative Period; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011468:Prostatectomy / Q000379:methods*; D011677:Punctures