From the Guidelines
The deep circumflex iliac artery and the inferior epigastric artery are not the primary concerns during port placement in surgery, instead, the focus should be on avoiding the external iliac artery branches, specifically the deep circumflex iliac artery is not a branch of the external iliac artery, but the inferior epigastric artery is, which arises from the external iliac artery. When placing laparoscopic ports, surgeons should identify and avoid the external iliac artery and its branches, to prevent injuring these vessels and causing significant hemorrhage.
- The external iliac artery is a major artery that runs along the pelvic wall and gives off several branches, including the inferior epigastric artery.
- The inferior epigastric artery arises from the external iliac artery and runs vertically in the posterior rectus sheath, making it vulnerable to injury during trocar insertion.
- To avoid this complication, surgeons should use transillumination of the abdominal wall when possible to visualize the vessel's course, directly observe the insertion site from within the abdomen after initial port placement, and consider using ultrasound guidance in difficult cases.
- If the external iliac artery or its branches are injured, immediate recognition and control of bleeding is essential, which may require suturing, clips, or electrocautery depending on the extent of injury 1.
From the Research
Artery to be Avoided During Port Placement
To prevent bleeding during surgery, it is essential to avoid the inferior epigastric artery (IEA) during port placement. The IEA is a branch of the external iliac artery that is at risk of injury in laparoscopic surgery 2, 3, 4.
Location of the Inferior Epigastric Artery
The IEA is located in the anterior abdominal wall, and its course can be variable. Studies have shown that the IEA is approximately 38-40% from the midline to the anterior superior iliac spine (ASIS) 2, 4. The artery's distance from the midline can be measured at different landmarks, such as the mid-inguinal point, ASIS, and umbilicus 4.
Safe Zone for Port Placement
To avoid injuring the IEA, it is recommended to insert trocars more than two-thirds of the distance along a horizontal line between the midline and the ASIS 2. Additionally, the lowest part of the abdomen lateral to the artery is considered a safe zone for port placement, as IEA branches are least frequently found in this area 2. A security distance of 6 cm at the level of ASIS and 9 cm at the level of umbilicus is also recommended for safe trocar placement 4.
Key Points to Consider
- The IEA is a branch of the external iliac artery that should be avoided during port placement.
- The artery's course can be variable, and its location should be considered when inserting trocars.
- A safe zone for port placement can be determined by measuring the distance from the midline to the ASIS and inserting trocars more than two-thirds of this distance.
- Preoperative assessment of the IEA can help reduce the risk of injury 4.