Using A Cadaveric Model To Map The Epigastric Artery

Objective: Injury of the vessels of the anterior abdominal wall occurs in 0.2%-2% of laparoscopic surgeries, most commonly in the inferior epigastric artery (IEA). The objective of this study was to use surface landmarks on the abdominal walls of cadaver models to map areas of safe trocar placement to avoid injury to the inferior and superior epigastric arteries.Materials and Methods: This was a prospective, noncomparative study conducted at an anatomy laboratory in an academic university hospital. Twenty formalin-fixed cadavers were obtained by the anatomy laboratory from May 2017 to August 2017. The inferior and superior epigastric arteries were dissected bilaterally in all cadavers. The rectus sheath was divided for adequate exposure of the entire length of the arteries from the pubic bone to the costal margin. Two reference points were defined. Point A was halfway between the umbilicus and the anterior superior iliac spine. Point B was 3 cm below the costal margin on the midclavicular line (known as Palmer's point on the left side). The distance from Point A and Point B to the inferior epigastric artery and superior epigastric artery, respectively, were measured bilaterally.Results: Twenty formalin-fixed cadavers were dissected, for a total of forty epigastric arteries. Twelve female and 8 male cadavers were included. The mean distance from Point A to the IEA was 1.61.0 cm. The artery was always on or medial to Point A. The mean distance from Point B to the superior epigastric artery (SEA) was 1.1 +/- 0.6 cm. The SEA was always on or medial to Point B.Conclusions: In trocar placement during laparoscopic surgery, staying lateral to a vertical line drawn from Point A to Point B can avoid the inferior and superior epigastric arteries. (J GYNECOL SURG 20XX:000)