Safety Zones for Anterior Abdominal Wall Entry During Laparoscopy

Saber, Alan A.; Meslemani, Ali M.; Davis, R. Benjamin; Pimentel, Ronald

doi:10.1097/01.sla.0000109151.53296.07

Cited by 126 publications

(94 citation statements)

References 8 publications

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“…Optimal cosmetic results are obtained through intraumbilical incision as the scar will be concealed within the umbilicus but a major concern may be injury to the epigastric vessels. 41 Advantages to infraumbilical or suprapubic incisions include safety and reduced risk of incisional hernia. 42 SPILS may increase hernia risk as they necessitate midline fascial incisions.…”

Section: Discussionmentioning

confidence: 99%

Technical approaches to single port/incision laparoscopic appendicectomy: a literature review

Rehman¹,

Ahmed

2011

annals

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INTRODUCTION Single port/incision laparoscopic surgery (SPILS) is a modern advancement toward stealth surgery. Despite the paucity of high-quality scientific studies assessing its effectiveness, this procedure is being used increasingly. This review aims to describe commonly used techniques for SPILS appendicectomies (SPILA), to summarise complication rates in the literature and to provide discussion on indications and implementation. METHODS All available databases including the Cochrane Central Register of Controlled Trials, MEDLINE ® and Embase ™ were searched in February 2011 and cross-referenced for available English literature describing SPILA in patients of any age. RESULTS Three broad technical approaches are described: procedures using laparoscopic instruments through a single skin incision in the abdominal wall, regardless of the number of fascial incisions, with or without the additional use of percutaneous sutures or wires to 'assist' the operation, and hybrid procedures, in which the appendix is exteriorised using a single incision laparoscopically assisted operation but subsequently divided using a conventional 'open' appendicectomy technique. Complication rates seem to be highest in SPILA procedures unassisted by sutures or wires. CONCLUSIONS Future research assessing the efficacy of single incision laparoscopic procedures should consider variation in technique as a possible factor affecting outcome.

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Section: Discussionmentioning

confidence: 99%

Technical approaches to single port/incision laparoscopic appendicectomy: a literature review

Rehman¹,

Ahmed

2011

annals

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“…However, radiologic studies documenting the course of inferior epigastric vessels, their artery-vein variations, and their distances to the midline are limited in number (1)(2)(3)(4).…”

Section: Discussionmentioning

confidence: 99%

Two-detector Computed Tomography Map of the Inferior Epigastric Vessels for Percutaneous Transabdominal Intervention Procedures

Gençhellaç¹,

Dursun²,

Temízöz³

et al. 2014

Balkan Med J

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The routine application of various percutaneous abdominal interventions for diagnostic and treatment procedures, such as paracentesis, peritoneal dialysis catheter procedures, tru-cut or fine needle biopsies, manipulation of laparoscopic instruments, insertion of sutures and drains, radiofrequency thermal ablation, abscess drainage, and endoscopic gastrostomy, has increased over the past two decades. Although these procedures can be performed safely, with or without imaging guiding, some complications may occur. Inferior epigastric artery (IEA) injuries are one of the major types of puncture site-related complications that occur in mid and lower abdominal percutaneous interventions. Therefore, it is crucial to be aware of anatomical variations and the exact course of the IEA to prevent any complications during percutaneous abdominal interventions.Several computed tomography (CT) studies have been published documenting the distance from the IEA to the midline, at different levels in randomized patients (1), and mapping the IEAs and their branches in selected cases (2-4). However, few multidetector CT (MDCT) studies have been performed on the general population revealing the abdominal course of an IEA and measuring its distance to the midline at different levels (5, 6).The purpose of this study was to map the inferior epigastric vessels using reconstructed two-detector computed tomography (TDCT) images and to measure distances from the IEA to the midline to determine a safe route for percutaneous abdominal interventions. MATERIAL AND METHODS Patient populationThe study population was selected from among patients who underwent contrast-enhanced abdominal MDCT examinations in our picture archiving and communication system (PACS). Approval from the Ethical Committee of the hospital was obtained (TÜTF-GOKAEK 2013/49). Medical documentation for each of the selected patients was available. MDCT examinations were performed for various reasons including follow-up of known abdominal disorders, primary or metastatic tumor investigations of different organs, vascular pathologies, and to evaluate infectious diseases. Patients with Background: It is crucial to know anatomic variations and the exact course of an inferior epigastric artery (IEA) to prevent any complications during percutaneous abdominal interventions. Aims: The aim of this study was to map the inferior epigastric vessels using reconstructed two-detector computed tomography images and measure the distance from the inferior epigastric artery (IEA) to the midline to determine a safe route for percutaneous abdominal interventions. Study Design: Retrospective comparative study. Methods: Coronal reconstructed two-detector computed tomography images of 200 patients were evaluated to measure the distances between the IEA and midline at three levels (origin, middle, and distal). Vein and artery arrangements were documented. Results:The most frequently encountered arrangement (41.5%) was a single vein and artery on both sides. Mean distances on the right and left sides we...

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“…31 Any procedures penetrating the abdominal wall can therefore risk injury to the IEA. Although IEA pseudoaneurysms remain a rare event, the rate of incidence appears to be increasing gradually, with 69% of the 32 known cases from the last 40 years presenting since 2000.…”

Section: Discussionmentioning

confidence: 99%

Inferior epigastric artery pseudoaneurysms

Edwards

Avula

Babu

et al. 2015

annals

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INTRODUCTION Inferior epigastric artery (IEA) pseudoaneurysms are recognised complications of abdominal wall procedures, and a variety of approaches including surgical excision and ligation, percutaneous procedures and conservative management have been employed in treating this rare complication. METHODS We describe a case of an IEA pseudoaneurysm diagnosed on computed tomography (CT) angiography, 14 days following a laparoscopic assisted low anterior resection, which was managed successfully with surgical excision and ligation. A review of the literature identified 32 reports of this complication since 1973 with 69% of cases occurring since 2000. FINDINGS The main aetiology of IEA pseudoaneurysm was abdominal surgery (n=20); 65% of cases were attributable to abdominal wound closure or laparoscopic surgery. Two-thirds (66%) of patients presented between 11 and 63 days, and all except 1 case presented with discomfort, abdominal mass or haemodynamic instability. Colour Doppler ultrasonography was the imaging modality of choice (n=18), either alone or in combination with computed tomography and/or angiography. Surgical ligation and excision and percutaneous coil embolisation formed the mainstay of attempted treatments (69%), particularly following treatment failure using an alternative technique. CONCLUSIONS The incidence of iatrogenic IEA pseudoaneurysms appears to be increasing. Awareness of this rare complication is of clinical importance to avoid excessive morbidity for affected individuals.

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Safety Zones for Anterior Abdominal Wall Entry During Laparoscopy

Abstract: Epigastric vessels are usually located in the area between 4 and 8 cm from the midline. Staying away from this area will determine the safe zone of entry of the anterior abdominal wall.

Cited by 126 publications

References 8 publications

Technical approaches to single port/incision laparoscopic appendicectomy: a literature review

Technical approaches to single port/incision laparoscopic appendicectomy: a literature review

Two-detector Computed Tomography Map of the Inferior Epigastric Vessels for Percutaneous Transabdominal Intervention Procedures

Inferior epigastric artery pseudoaneurysms

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