Relative Position Of The Umbilicus And 5cm Above Umbilicus And Retroperitoneal Vascular

Objective: By studying the umbilicus /5cm above umbilicus and retroperitoneal vascular relative position to explore how to enhanced laparoscopic surgery first time puncture safety.Methods: patients who will have digital subtraction angiography (DSA) need positioning, and patients who will have CT do not need positioning. Imaging in all patients use abdominal aortic bifurcation as a reference point (0 point), observe the relative position of umbilicus projection and abdominal aorta/iliac artery projection; and the relative position of 5cm above the umbilicus projection and the abdominal aorta projection. Keep record of the relative position of umbilicus projection and abdominal aortic/iliac arteries projection; keep record of the relative position of umbilicus projection and abdominal aortic bifurcation; measure the vertical distance of the projection of the umbilicus and the abdominal aortic bifurcation;Keep record of the relative position of 5cm above the umbilicus projection and the abdominal aortic projection. Measure the vertical distance of the two projections mentioned above. Results: major patients the projection of the umbilicus is on the retroperitoneal great vessels, including on the abdominal aorta, on the abdominal aortic bifurcation, on the right iliac artery , and on the left iliac artery. Minor patients the projection of the umbilicus are not on any vessel. Difference between the two groups was significant (P<0.05). Compare with different weight group, it is statistically significant between the BMI change and retroperitoneal vascular projection to umbilical projection position change (P<0.05), the same with umbilicus projection and abdominal aortic bifurcation position (P<0.05). Major patients' 5cm above the umbilicus projections are on the abdominal aorta.Compared with different BMI groups, the differences between the groups were statistically significant (P<0.05).Conclusion: In a nutshell, the umbilicus projection is on the abdominal aortic or right iliac artery ,thus abdominal aorta and the right common iliac artery are at greater risk when retroperitoneal vascular injured during the first insert in a laparoscopic surgery. With the increase of BMI, the projection of the umbilicus can move below the abdominal aortic bifurcation. While the projection of 5cm above the umbilicus usually is on the abdominal aorta, very rarely on the left of abdominal aorta. Therefore, abdominal aorta is at very great risk when patients with severe pelvic adhesions having laparoscopic surgery puncturing at 5cm above the umbilicus. The risk of retroperitoneal vascular injury becomes less and the projection of umbilicus moves to the right of abdominal aorta with the increase of BMI.