ABSTRACT
Major vessel injuries during laparoscopy most commonly occur during insertion of Veress needle and port trocars through the abdominal wall. This article reviews methods for avoiding major vessel injury while gaining laparoscopic access, including anatomic relationships of abdominal wall landmarks to the major retroperitoneal vessels. Methods for periumbilical placement of the Veress needle and primary trocar are reviewed in terms of direction and angle of insertion, and alternative methods and locations are discussed. Methods for secondary port placement are reviewed in terms of direction, depth, and speed of placement.
Subject(s)
Blood Vessels/injuries , Gynecologic Surgical Procedures/adverse effects , Intraoperative Complications/prevention & control , Laparoscopy/adverse effects , Surgical Instruments , Aorta, Thoracic/injuries , Female , Humans , Iliac Artery/injuries , Iliac Vein/injuries , Intraoperative Complications/epidemiology , Laparoscopy/methods , Needles , Obesity , Overweight , Venae Cavae/injuriesABSTRACT
OBJECTIVE: To determine the ideal angle for insertion of laparoscopic instruments at Palmer's point. STUDY DESIGN: Abdominal magnetic resonance images were reviewed for 75 women between ages 18 and 50 years old. The distance from the skin to the retroperitoneal structures were determined perpendicular to the spine and angled 45 degrees caudally. RESULTS: When instruments are inserted perpendicular to the skin in the axial plane and peritoneum perpendicular to the spine, the distance from skin to posterior was 10.0 +/- 0.2 cm and to the aorta was 11.3 +/- 0.2 cm. If instruments are inserted at an angle 45 degrees caudally, this distance increased to 16.6 +/- 0.2 cm. CONCLUSION: When inserting laparoscopic instruments at Palmer's point, insertion perpendicular to the skin in the axial plane and angled 45 degrees caudally in relation to the spine offers an increased margin of safety compared with insertion perpendicular to the spine, particularly in thin women.
