AAGL 2012: Establishing Safe Zones for Laparoscopic Port Placement in Obese Patients

In obese patients, laparoscopic ports should be placed more than 10 centimeters from the midline to minimize the chance of injury to epigastric vessels, according to research presented at the 41st Global Congress of the American Association of Gynecologic Laparoscopists. Previous studies have mapped safe zones at greater than 8 centimeters from the midline.

Arturo Garza-Cavazos, MD, Instructor at Southern Illinois University and Minimally Invasive Gynecologic Surgery Fellow, et al, performed a retrospective analysis of 250 randomly selected patients who had undergone an abdominal and pelvic computed tomography (CT) with intravenous contrast. All patients were at least 18 years of age. Patients with a condition that could alter the location of the epigastric vessels, such as large tumors or a ventral hernia, were excluded. A total of 194 images were included.

Patients were stratified according to the World Health Organization’s classifications for obesity: Normal (BMI 18.50-24.99), Overweight (BMI 25-29.99), Obese (BMI 30-34.99), Obese II (BMI 35-39.99), and Obese III (BMI ≥40). The authors mapped the locations of epigastric vessels at five levels: the xyphoid; midway between the xyphonid and the anterior superior iliac spine (ASIS); the ASIS; midway between the ASIS and symphisis pubis (PS); and the PS.

The authors found that the average distance from midline to epigastric vessels increased along with BMI. For patients with a BMI less than 35, previously established safe zones remain the same. For patients with a BMI greater than 35, ports should be placed greater than 10cm from midline to minimize vessel injury.