Laparoscopic appraisal of the anatomic relationship of the umbilicus to the aortic bifurcation

Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California, United States
The Journal of the American Association of Gynecologic Laparoscopists (Impact Factor: 1.61). 06/1998; 5(2):135-140. DOI: 10.1016/S1074-3804(98)80079-0


AbstractStudy Objective. To determine the cephalocaudal relationship among the umbilicus, aortic bifurcation, and iliac vessels by direct measurement during laparoscopy.Design. Prospective, consecutive study (Canadian Task Force classification II-1).Setting. Tertiary referral center.Patients. Ninety-seven women undergoing operative laparoscopy.Interventions. The distance from the aortic bifurcation relative to the umbilicus was measured in both the supine and Trendelenburg positions with a marked suction-irrigator probe. Patients were stratified into three groups based on body mass index (kg/m2). The anatomic location of the common iliac vessels and course of the left common iliac vein were identified in 68 women.Measurements and Main Results. The position of the aortic bifurcation ranged from 5 cm cephalad to 3 cm caudal to the umbilicus in the supine position, and from 3 cm cephalad to 3 cm caudal in the Trendelenburg position. In the supine position, the aortic bifurcation was located caudal to the umbilicus in only 11% of patients compared with 33% in the Trendelenburg position. This difference was statistically significant for the total study population (p<0.0001) and for the nonoverweight group (p<0.01). In both positions no significant correlation was found between the distance from the aortic bifurcation to the umbilicus and body mass index. Mean±SD distance of the aortic bifurcation from the umbilicus in the supine position was 0.1±1.2 cm for the nonoverweight group, 0.7±1.5 cm for the overweight group, and 1.2±1.5 cm for the very overweight group. Respective values in Trendelenburg position were 1.0±1.1, −0.4±1.2, and −0.2±1.3 cm. The common iliac artery was caudal to the umbilicus in four women. The space between common iliac arteries was always at least partly occupied by the left common iliac vein, and was completely filled in 19 women (28%).Conclusions. The cephalocaudal relationship between the aortic bifurcation and umbilicus varies widely and is not related to body mass index in anesthetized patients. Regardless of body mass index, the aortic bifurcation is more likely to be located caudal to the umbilicus in the Trendelenburg compared with the supine position. Its presumed location can be misleading during Veress needle or primary cannula insertion, and a more reliable guide is necessary for this procedure to avoid major retroperitoneal vascular injury.

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    • "As laparoscopic operation is performed increasingly for abdominal and pelvic surgery, its potential for complications must be clearly understood [1]. Laparoscopic entry is of primary importance in laparoscopic surgery because of its potential association with serious complications such as visceral and vascular injuries. "
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    ABSTRACT: To evaluate the vertical distance between umbilicus to aortic bifurcation on coronal view in Korean women and their relation with body mass index (BMI) and woman's age. This retrospective study included 257 women who visited emergency center at university-based hospital from January to December 2011. All women underwent abdomino-pelvic computerized tomography (CT) due to various symptoms in a supine position. By using the electronic coronal CT images, the vertical distance between umbilicus and aortic bifurcation was measured. If aortic bifurcation was located below umbilicus, the distance was expressed as minus value (i.e., caudal to umbilicus). Age of woman, body weight, height and calculated BMI (kg/m(2)) were also recorded. Aortic bifurcation was located caudal to umbilicus in 52.9% and cephalad to umbilicus in 37.4%. The vertical distance had a negative relationship with BMI (r=.0.180, P=0.004), as well as woman's age (r=-0.382, P<0.001). However, a multivariate analysis revealed that the vertical distance had a significant negative relationship with woman's age (P<0.001) but not with BMI (P=0.510). An equation could be drawn to estimate the vertical distance by using woman's age and BMI: vertical distance (mm)=12.6-0.3×(age)-0.2×(BMI). The vertical distance from umbilicus to aortic bifurcation on coronal view showed a significant inverse correlation with woman's age, however, the distances varied widely. Most older or obese Korean women had aortic bifurcation caudal to umbilicus.
    Full-text · Article · Jan 2014
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    • "The umbilicus is the most common site or reference point for access. When the patient is supine the aortic bifurcation can range from 5 cm cephalad to 3 cm caudal to the umbilicus, and from 3 cm cephalad to 3 cm caudal when in the Trendelenburg position [15]. Body habitus is also important in this regard. "
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    ABSTRACT: Objectives To describe the incidence, identification and management of common intraoperative complications, including vascular, urological, bowel and visceral complications, of laparoscopic urological surgery.Methods We searched the databases of PubMed and Medline for relevant English language reports, using the keywords ‘laparoscopy’, ‘urologic’ and ‘complication’.ResultsThe search yielded 967 papers in all, and a review of these yielded a total of 42 relevant papers.Conclusion Despite its advantages, laparoscopic urological surgery is associated with complications having rates as high as 22%. As surgical volumes increase, the incidence and magnitude of complications have increased progressively. Meticulous surgical technique, surgeon experience, and a high degree of suspicion are necessary throughout the surgical endeavour. The intraoperative recognition and management of complications is mandatory.
    Full-text · Article · Mar 2012 · Arab Journal of Urology

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