title: Safe introduction of ancillary trocars in gynecological surgery: the "yellow island" anatomical landmark.
abstract: OBJECTIVE
  This technical note aims to suggest a safe introduction of ancillary trocars in gynaecological surgery, in order to prevent inferior epigastric artery damage.
  
  
  METHODS
  We performed a narrative overview, synthesizing the findings of literature retrieved from searches of computerized databases.
  
  
  RESULTS
  Among the different techniques, the identification of the "yellow island" as anatomical landmark seems to be a useful aid to avoid complication. This particular landmark is identified taking the lateral third of a line between the anterior superior iliac spine and the umbilicus as reference points, by a subperitoneal accumulation of adipose tissue located in that area.
  
  
  CONCLUSIONS
  "Yellow island" could be considered a safe place for trocars introduction because epigastric artery never runs there, even in patients with particular anatomical variants. This technique is particularly useful in obese patients, in which "yellow island" appears to be more evident respect to lean ones. Furthermore, the use of "open" trocars insertion may reduce the possibility of epigastric artery lesions respect to "Verres needle technique".
  
  
  CONCLUSIONS
  The identification of the "yellow island" anatomical landmark could be considered an useful aid for the safe introduction of ancillary trocars in gynaecological surgery.
  
  
  BACKGROUND
  Gynaecology, Laparoscopic surgery, Trocars placement.
authors.forename: Salvatore Giovanni
authors.initials: SG
authors.lastname: Vitale
authors.forename: Nicola
authors.initials: N
authors.lastname: Gasbarro
authors.forename: Antonio Simone
authors.initials: AS
authors.lastname: Lagana
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Sapia
authors.forename: A M C
authors.initials: AMC
authors.lastname: Rapisarda
authors.forename: Gaetano
authors.initials: G
authors.lastname: Valenti
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: Trovato
authors.forename: Diego
authors.initials: D
authors.lastname: Rossetti
authors.forename: Benito
authors.initials: B
authors.lastname: Chiofalo
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Barrasso
authors.forename: Andrea
authors.initials: A
authors.lastname: Tinelli
authors.forename: Francesco
authors.initials: F
authors.lastname: Corrado
mesh_terms: D000005:Abdomen / Q000033:anatomy & histology; D019074:Epigastric Arteries / Q000293:injuries*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D010535:Laparoscopy; D061214:Patient Safety; D013525:Surgical Instruments