Surface anatomy of the inferior epigastric artery in relation to laparoscopic injury

Abstract

The inferior epigastric artery (IEA) is at risk of injury in laparoscopic surgery. Current descriptions of the course of the IEA do not provide surface landmarks useful to the surgeon. This study aimed to define surface relations and propose guidelines for safer trocar placement. The posterior surfaces of the anterior abdominal walls of 30 preserved cadavers were dissected. The surface anatomy of 60 IEAs and their branches were defined. At the level of the anterior superior iliac spine (ASIS), the IEA is 38% +/- 18% (95% confidence interval [CI]) from the midline to the ASIS. At the mid-inguinal point the relation is 40% +/- 17% and at the umbilicus 40% +/- 22%. The pattern of branches is highly variable. Although giving guidelines for trocar insertion can be treacherous, we found the following to be of value: 1) the midline is avascular; 2) the main stem of the IEA will be avoided if trocars are inserted more than two-thirds of the distance along a horizontal line between the midline and the ASIS; and 3) IEA branches are least frequently found in the lowest part of the abdomen lateral to the artery.