THE LOCATION OF ABDOMINAL-WALL BLOOD-VESSELS IN RELATIONSHIP TO ABDOMINAL LANDMARKS APPARENT AT LAPAROSCOPY

OBJECTIVE: Our purpose was to evaluate the location of the major blood vessels of the abdominal wall relative to landmarks apparent at lapar oscopy. STUDY DESIGN: Abdominal computed tomographic images of 21 repr oductive-aged women at an academic center were retrospectively reviewe d to determine the location of the inferior epigastric, superficial ep igastric, and superficial circumflex iliac arteries and the lateral re ctus muscle margins in relation to the symphysis pubis, the umbilicus, and the abdominal midline. These locations were correlated with each other and with body mass index using Pearson's correlation coefficient . RESULTS: Above the symphysis the inferior and superficial epigastric arteries were 5.6 +/- 1.0 cm (mean +/- SD) and 5.5 +/- 2.0 cm from th e midline, respectively. Although the location of these two vessels co rrelated (r = 0.6, p = 0.02), the mean difference in their location wa s 1.4 +/- 1.1 cm. Near the level of the umbilicus the superficial epig astric and circumflex iliac arteries and the lateral rectus muscle mar gin were 4.6 +/- 1.4 cm, 10.7 +/- 1.7 cm, and 7.6 +/- 1.5 from the mid line, respectively. Only the lateral rectus muscle margin correlated w ith body mass index (r = 0.65, p = 0.004). CONCLUSION: When laparoscop ic landmarks are not visible to guide placement, lateral trocars shoul d be placed approximately 8 cm from the midline and at least 5 cm abov e the symphysis to minimize the risk of vessel injury.