ARTERIAL RISKS IN CELIOSURGERY

It is important to recognize exceptional vascular events in celiosurge ry because of their gravity. Most occur during pneumoperitoneal manoeu vres using a Palmer needle and rarely at the insertion of the first tr ocar. We performed a tomodensitometric study in 200 subjects free of a bdominal pathology in order to determine the distance from the umbilic us to the aortic bifurcation, their projection over the spine and the superficial relations of the large vessels to the cutaneous umbilical cover. Generally, the projections of the umbilicus, and also the aorti c bifurcation, lie over L4. The distance between the skin and the larg e retroperitoneal vesses is generally equal to one-third of the antero -posterior abdominal diameter. In thin subjects with a flat abdomen ho wever, this distance may be smaller, even less than 3 cm. These findin gs emphasize the importance of <<safety>> manoeuvres during celiosurge ry, especially during the learning period.