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Original Papers

Using the internal inguinal ring as a landmark for the safe placement of secondary trocars at laparoscopy

Authors:

D. M. C. S. Jayasundara ,

University of Peradeniya, LK
About D. M. C. S.
Senior Lecturer in Obstetrics and Gynaecology,
Department of Obstetrics and Gynaecology, Faculty of Medicine
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H. M. Senanayake,

University of Colombo, LK
About H. M.
Chair Professor of Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, Faculty of Medicine
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S. H. M. E. C. Samarasinghe

Teaching Hospital, Peradeniya, LK
About S. H. M. E. C.
Registrar in Radiology
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Abstract

Aim

Avoidance of injury to the epigastric vessels is an important safety consideration in siting secondary ports at laparoscopy. We evaluated trans-illumination, direct visualization of vessels and using the internal inguinal ring, which has a constant relationship with the inferior epigastric vessels as an anatomical landmark to locate these vessels.

Methods

Ninety consecutive women undergoing laparoscopy were recruited for the study. The Ability to trans-illuminate the superficial and inferior epigastric vessels, to visualize inferior epigastric vessels and to locate the round ligament entering the internal inguinal ring were documented. The body mass index (BMI) was noted. The association of the body mass index (BMI) with these variables was calculated by simple regression analysis.

Results

Ability to visualize the internal inguinal ring was significantly higher than that of locating the superficial or inferior epigastric vessels by trans -illumination or by directvisualization. p<0.001.

Ability to visualize and to trans -lluminatethe inferior epigastric vessels decreased with increasing BMI (p< 0.05). There was no significant relationship between body mass index and the ability to visualize the round ligament entering the deep inguinal ring. (p=0.64)

Conclusion

Locating the deep inguinal ring and using it as an anatomical landmark and placing the lateral trocars lateral to a saggital line originating from the internal ring is a reliable and useful method in preventing unintended injury to anterior abdominal wall vessels during secondary trocar placement
DOI: http://doi.org/10.4038/sljog.v38i2.7789
How to Cite: Jayasundara, D.M.C.S., Senanayake, H.M. & Samarasinghe, S.H.M.E.C., (2016). Using the internal inguinal ring as a landmark for the safe placement of secondary trocars at laparoscopy. Sri Lanka Journal of Obstetrics and Gynaecology. 38(2), pp.27–29. DOI: http://doi.org/10.4038/sljog.v38i2.7789
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Published on 08 Nov 2016.
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