M. Possover et al., LEFT-SIDED LAPAROSCOPIC PARAAORTIC LYMPHADENECTOMY - ANATOMY OF THE VENTRAL TRIBUTARIES OF THE INFRARENAL VENA-CAVA, American journal of obstetrics and gynecology, 179(5), 1998, pp. 1295-1297
OBJECTIVE: We evaluated the anatomy of the infrarenal portion of the h
uman inferior vena cava and their ventral tributaries by video laparos
copy. STUDY DESIGN: A total of 112 patients underwent laparoscopic par
a-aortic lymphadenectomy for gynecologic malignancies. All procedures
were videotaped. The number and anatomic distribution of the infrarena
l tributaries of the anterior part of the inferior vena cava was evalu
ated retrospectively from videotapes. The inferior vena cava was divid
ed into 3 levels: the area of the bifurcation of the vena cava (level
1), the area between the bifurcation and the inferior mesenteric arter
y (level 2), and the area between the inferior mesenteric artery and t
he right ovarian vein (level 3). RESULTS: Tributaries were found in le
vel 1 in 65 (58%) patients, in level 2 in 22 (19.6%) patients, and in
level 3 in 1 (0.90%) patient; in 24 (21.5%) patients no tributaries we
re found. A total of 237 tributaries was counted: 82.3% (195 of 237) w
ere located at level 1, 17.3% (41 of 237) at level 2, and 0.4% (1 of 2
37) at level 3. Patients with tributaries had a mean of 3 tributaries
in level 1, a mean of 1.7 tributaries in level 2, and 1 patient had 1
tributary in level 3. CONCLUSIONS: The ventral tributaries of the infe
rior vena cava show a specific distribution pattern. The knowledge of
these anatomic landmarks can be important for laparoscopic surgeons to
avoid accidental injury.