Using a Cadaveric Model to Map the Epigastric Arteries

INTRODUCTION: Injury of the vessels of the anterior abdominal wall occurs in 0.2-2% of laparoscopic surgeries. The purpose of this study is to use surface landmarks on the abdominal wall of cadaver models to map out areas of safe trocar placement to avoid the inferior and superior epigastric arteries. METHODS: The inferior and superior epigastric arteries were dissected bilaterally in twenty formalin fixed 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 3cm 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 eight male cadavers were included. The mean distance from point A to the inferior epigastric artery was 1.6 +/- 1.0 cm. The artery was always on or medial to point A. The mean distance from point B to the superior epigastric artery was 1.1 +/- 0.6 cm. The artery was always on or medial to point B. CONCLUSION: In trocar placement during laparoscopic surgery, staying lateral to a vertical line drawn from point A to point B is very likely to avoid the inferior and superior epigastric artery.