Anatomic guidelines for the prevention of abdominal wall hematoma induced by trocar placement

Balzer, K.; Witte, Hartmut; Recknagel, S; Kozianka, J; Waleczek, H.

doi:10.1007/s00276-999-0087-9

Cited by 30 publications

(14 citation statements)

References 6 publications

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“…An anatomical study of 21 cadavers, in which the course of the inferior epigastric arteries and the ascending branches of the deep circumflex iliac artery was pursued, showed that half of the 36 trocar insertion sites recommended in the common literature imply the risk of injury to these arteries. Therefore, the authors suggested the following insertion sites: ventral midline, and in a zone of 5-cm width lateral to the lateral border of the rectus sheath [22]. Another important anatomical relationship is the distance between the skin and the retroperitoneal vascular structures at the level of the umbilicus, which can be reduced to less than 2 cm, particularly in thin anaesthetised patients with muscle relaxation [23].…”

Section: Discussionmentioning

confidence: 98%

Bleeding remains a major complication during laparoscopic surgery: analysis of the SALTS database

Opitz

Gantert

Giger

et al. 2005

Langenbecks Arch Surg

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Although the initial learning curve of laparoscopic procedures is probably finished, the rate of bleeding complications is still substantial. These results demonstrate that the collection of data in the form of multicentre studies is essential for quality control. It permits recognition and understanding of the current problems in laparoscopic surgery in order to improve the quality of daily surgical practice. The fact that the operator's experience seems to play an important role shows that improvement in learning and teaching programmes is still necessary and should be coordinated on a national basis.

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Section: Discussionmentioning

confidence: 98%

Bleeding remains a major complication during laparoscopic surgery: analysis of the SALTS database

Opitz

Gantert

Giger

et al. 2005

Langenbecks Arch Surg

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“…8 Iatrogenic hematomas from injuries to the deep circumflex iliac artery as a result of trocar placement during laparoscopic surgery have also been reported in recent years. 9,10 Predisposing factors for spontaneous hemorrhage of the abdominal wall include the following factors: (a) overcontraction or overstretching of the muscle as a result of coughing, sneezing, straining, twisting, vomiting, etc. ; (b) weakness of the vessel wall or decrease in muscular resistance as a result of hypertension, arteriosclerosis, old age, obesity, pregnancy, previous surgery, trauma, inflammatory disease, etc.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Hematoma of the Lateral Abdominal Wall Caused by a Rupture of a Deep Circumflex Iliac Artery: Report of Two Cases

Shimizu

Hanasawa

Yoshioka³

et al. 2003

Surgery Today

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Expanding hematoma of the abdominal wall is a rare example of acute abdominal disease. We report two cases of lateral abdominal wall hematoma caused by the rupture of a deep circumflex iliac artery, which is a rare cause of an abdominal wall hematoma. Both patients experienced severe abdominal pain after sneezing or coughing. In both cases, computed tomography (CT) findings suggested that active bleeding was continuing. Emergent angiography was therefore performed, and the hematoma was embolized using Spongel or Microcoils. Ultrasound examinations were repeatedly used to monitor the size of the hematoma. The size of the hematoma and patient's pain gradually decreased after embolization. Ultrasound and CT examinations provided useful information for the differential diagnosis of this disease. We conclude that emergent angiography should be performed to control bleeding and avoid any unnecessary surgical procedures in patients with hematoma of the abdominal wall.

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“…Nonetheless, for the left hypochondrium puncture one must take into account the risk of injury to the superior epigastric vessels and structures immediately posterior to the anterior abdominal wall at the puncture site, such as the gastric body, transverse colon and greater omentum. However, the trunks and branches of larger caliber of the superior epigastric vessels never lie at a distance greater than eight centimeters from the midline of the abdomen, so punctures beyond that distance prevent lesions of those vessels [21][22][23] . The values of tests and parameters established to assess the safety in the development of pneumoperitoneum has been shown by Azevedo [16][17][18] in patients without previous abdominal surgeries, previous intra-abdominal inflammatory conditions and with a BMI below 30.…”

Section: Discussion Discussion Discussion Discussionmentioning

confidence: 99%

Punção com agulha de Veress no hipocôndrio esquerdo para a criação do pneumoperitônio: valor diagnóstico das provas de posicionamento da agulha em pacientes não selecionados

Becker

Azevedo

Azevedo³

et al. 2011

Rev. Col. Bras. Cir.

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Veress needle insertion into the left hypochondrium for creation of pneumoperitoneum: diagnostic value of tests to determine the position of the needle in unselected patients Original Article Original Article Original Article Original Article Original Article Veress needle insertion into the left hypochondrium for creation Veress needle insertion into the left hypochondrium for creation Veress needle insertion into the left hypochondrium for creation Veress needle insertion into the left hypochondrium for creation Veress needle insertion into the left hypochondrium for creation of pneumoperitoneum: diagnostic value of tests to determine the of pneumoperitoneum: diagnostic value of tests to determine the of pneumoperitoneum: diagnostic value of tests to determine the of pneumoperitoneum: diagnostic value of tests to determine the of pneumoperitoneum: diagnostic value of tests to determine the position of the needle in unselected patients position of the needle in unselected patients position of the needle in unselected patients position of the needle in unselected patients position of the needle in unselected patients Punção com agulha de Veress no hipocôndrio esquerdo para a criação do Punção com agulha de Veress no hipocôndrio esquerdo para a criação do Punção com agulha de Veress no hipocôndrio esquerdo para a criação do Punção com agulha de Veress no hipocôndrio esquerdo para a criação do Punção com agulha de Veress no hipocôndrio esquerdo para a criação do pneumoperitônio: valor diagnóstico das provas de posicionamento da agulha em pneumoperitônio: valor diagnóstico das provas de posicionamento da agulha em pneumoperitônio: valor diagnóstico das provas de posicionamento da agulha em pneumoperitônio: valor diagnóstico das provas de posicionamento da agulha em pneumoperitônio: valor diagnóstico das provas de posicionamento da agulha em pacientes não selecionados pacientes não selecionados pacientes não selecionados pacientes não selecionados pacientes não selecionados OTÁVIO To assess the effectiveness of the Veress needle puncture in the left hypochondrium and the accuracy of the tests described for the intraperitoneal correct positioning of the tip of the Veress needle in an unselected population. Methods:Methods: Methods: Methods: Methods: Ninetyone patients consecutively scheduled for Videolaparoscopy had the abdominal wall punctured in the left hypochondrium. There were no exclusion criteria. The patients received general anesthesia and mechanical ventilation according to the protocol. After puncturing five tests were used to confirm the positioning of the needle tip within the peritoneal cavity: aspiration test -AT; resistance to infusion -Pres; recovery of the infused fluid -Prec, dripping test -DT, and test of initial intraperitoneal pressure -IIPP. The test results were compared with results from literature for groups with defined exclusion criteria. The results were used for calculating sensitivity (S) specificity (E), positive predictive value (PPV) and negative predictive value (NPV). Inferential...

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Anatomic guidelines for the prevention of abdominal wall hematoma induced by trocar placement

Cited by 30 publications

References 6 publications

Bleeding remains a major complication during laparoscopic surgery: analysis of the SALTS database

Bleeding remains a major complication during laparoscopic surgery: analysis of the SALTS database

Spontaneous Hematoma of the Lateral Abdominal Wall Caused by a Rupture of a Deep Circumflex Iliac Artery: Report of Two Cases

Punção com agulha de Veress no hipocôndrio esquerdo para a criação do pneumoperitônio: valor diagnóstico das provas de posicionamento da agulha em pacientes não selecionados

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