Anatomic guidelines for the prevention of abdominal wall hematoma induced by trocar placement

A knowledge of the parietal structures of the abdominal wall is necessary t o minimize risks of operative procedures like laparoscopy. For means to pre vent intraoperative bleeding and the occurrence of abdominal wall hematoma, we studied the course of the inferior epigastric arteries and the ascendin g branch of the deep circumflex iliac artery in 21 human cadavers. The abdo minal wall structures were dissected and the distances of the arteries in r elation to anatomic structures such as the umbilicus, pubic symphysis, supe rior ischial spine and lower edge of the rib-cage were measured. Comparison of the morphometric results obtained with the location of 36 trocar incisi on sites recommended in the common literature yields the information that a bout half of these incision sites incur the risk of injuring the arteries.