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Importance of Morphometric Analysis of Inferior Epigastric Artery with Reference to Laparoscopic Portal

Arun S. Karmalkar, Associate Professor, Department of Anatomy, D.Y. Patil Medical College, Kolhapur, Maharashtra 416006, India. , Arun S. Karmalkar1 , Ashalata D. Patil2 , Anita Gune3

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Indian Journal of Anatomy 7(4):p 371-375, July - August 2018. | DOI: http://dx.doi.org/10.21088/ija.2320.0022.7418.2

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Abstract

Introduction: Laparoscopy has been a choice of preference for various surgical procedures for more than two decades. Trocar and cannula are used to make required portals in the anterior abdominal wall for inserting laparoscope. Penetrating a pointed trocar is a blind method. Using the standard confirmed points for making portals, though secure, at times can lead to injury of blood vessels of anterior abdominal wall, mainly Inferior Epigastric Artery (IEA). Anatomical variations of IEA in origin, course, branching pattern and termination are well reported. Hence there is a necessityfor mapping of IEA to avoid vessel injury. Aim: The aim of present study is to map IEA in terms of its length from its origin, distances from midline extending from pubic symphysis to umbilicus and level of termination with relation to umbilicus. Materials and Method: Study was conductedon 50 formalin embalmed adult cadavers by direct dissection methodused for routineundergraduate teaching. IEA on both sides was dissected. Length, distance from midline with five reference points and termination with reference to umbilicus was recorded. Results: Length of IEA - On right side it ranged from 7.2 – 25cms with mean 14.68±4.78, on left side from 8- 24.3cms with mean 14.91±3.55. Our study concluded safety zone 5.3cm±1.92 on either side of midline. In our study 22% right IEA and 22% left IEA ended below the umbilicus. Conclusion: The trocars can be safely inserted at 5.3cms±1.92 away from the midline on both the sides. However, preoperative mapping of IEA will help in minimizing vessel injury during laparoscopic procedures. 

 

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DOI: http://dx.doi.org/10.21088/ija.2320.0022.7418.2

Keywords

Inferior Epigastric Artery; Length; Abdominalwall; Laparoscopy Injury; Portal; Safe Zone.

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