Supraumbilical primary trocar insertion for laparoscopic access: the relationship between points of entry and retroperitoneal vital vasculature by imaging

The Effect of Age and Body Mass Index on the Surgical Anatomy of Supraumbilical Port Insertion: Implications for Laparoscopic and Robotic Surgery

“…Overall, our study suggests that the distance to the great vessels (aorta and IVC) is equivalent at the umbilicus compared to supraumbilical locations (1–5 cm above the umbilicus). These results are corroborated in prior studies [9] and may translate to an overall similar risk of vessel injury between port sites; however, careful controlled entry is still essential, as distances may change based on individual patient characteristics. Furthermore, supraumbilical entry is associated with greater abdominal wall thickness, which may increase the risk of pre-peritoneal insufflation.…”

“…More specifically, our study demonstrated that patients with BMI < 30 had a skin-to-aorta distance < 7 cm and therefore are possibly at higher risk of injury. Interestingly, Stanhiser et al[9] showed no significant association between BMI and whether the aorta or another vessel was the most anterior vascular structure that was encountered. However, this observed difference may be explained by the fact that they reconstructed sagittal CT images into a three-dimensional model using imaging software, while we directly measured the anatomic relationships based on CT images directly.…”

“…Since standard Veress needles are 12 cm (and 15 cm for bariatric patients) [9] and at least 50% of the length is typically extracorporeal or within the abdominal wall, it can be reasonably assumed that, at most, 50% (or 7 cm) of Veress needle length resides within the peritoneal cavity upon insertion. Hence, we collectively proposed that > 7 cm would be reasonably safe distance from skin to superficial border of the great vessels.…”

“…However, Hurd et al[8] suggested that the risk of injury to retroperitoneal vessels theoretically increases with supraumbilical insertion in women with normal BMI. Conversely, Stanhiser et al[9] utilized three-dimensional modeling to show the distance to retroperitoneal vessels favored supraumbilical entry compared to the umbilicus, particularly at a 90-degree entry angle. However, the influence of age and BMI on the anatomic relationships governing supraumbilical entry has not been previously investigated.…”

A simple and safe method for creating closed pneumoperitoneum in slim patients with firm abdominal skin

“…5 However, the LDLT engages the Veress needle in such a way that it safeguards the intra-abdominal structures. This method has the potential to avoid repeated attempts to introduce the needle at the desired position, which can be frustrating and prolong the operating time.…”