Positional Anatomy of Vessels That May Be Damaged at Laparoscopy: New Access Criteria Based on CT and Ultrasonography to Avoid Vascular Injury

Abstract

The position of the umbilicus should not be relied on for access planning. The relation between the level of the ASIS and the aortic bifurcation is more consistent. The ideal primary port entry (or Veress needle site) is at the ASIS plane in the midline, and the ideal lateral port entry is in the same plane >6 cm from the midline. If the umbilicus is to be used, a Hasson insertion is desirable, but if a Veress needle is used at the umbilicus, an angle of 45 degrees in the sagittal plane should be used.