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Abdominal surgery: General principles of access
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Nigel J. Hall, Katherine A. Barsness
Once the initial trocar has been successfully placed into the peritoneal cavity, the telescope is instrumental to safe and efficient placement of successive trocars into the peritoneal space. An angled telescope (e.g. 30-, 45-, or 70-degree bevel) allows for visualization of the peritoneal surface of the anterior abdominal. In addition, the course of the epigastric artery can be identified, so that it is not inadvertently injured during port placement. A superior epigastric artery injury can result in a very painful rectus sheath hematoma. An inferior epigastric artery injury will bleed vigorously, due to the lack of a posterior rectus sheath to tamponade the flow of blood.
Applied Surgical Anatomy
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Vishal G Shelat, Andrew Clayton Lee, Julian Wong, Karen Randhawa, CJ Shukla, Choon Sheong Seow, Tjun Tang
What defines direct and indirect hernia anatomically when seen laparoscopically?Inferior epigastric artery
Standard autologous tissue flaps for whole breast reconstruction
Published in Steven J. Kronowitz, John R. Benson, Maurizio B. Nava, Oncoplastic and Reconstructive Management of the Breast, 2020
Steven J. Kronowitz, John R. Benson, Maurizio B. Nava
The deep inferior epigastric artery and venae originate from the external iliac artery, enter the deep lateral surface of the lower third of the rectus muscle, and divide into a series of vertical rows within the substance of the muscle. These rows give off perforating vessels that travel through the muscle and into the overlying fascia fat and skin. Hartrampf originally described four zones of perfusion to the lower abdomen for pedicled TRAM flaps: zone I directly over the ipsilateral rectus muscle; zone II across the midline over the contralateral muscle; zone III lateral to the ipsilateral muscle; and zone IV is the remaining area lateral to the contralateral rectus abdominis muscle.4 Greatest perfusion was thought to be in zones I and II, with lesser perfusion in zone III, and least perfusion in IV (Figure 22.5.2).
Comparison of 30-degree and 0-degree laparoscopes in the visualisation of the inferior epigastric vessel, rectus abdominis muscle and bladder dome in gynaecologic laparoscopy
Published in Journal of Obstetrics and Gynaecology, 2022
Satit Klangsin, Nantaka Ngaojaruwong, Hatern Tintara
In the lower abdominal wall, the inferior epigastric artery (IEA) mostly arises from the external iliac artery; however, variants may arise from the femoral artery or share a common trunk with the obturator artery (Wong and Merkur 2016). The IEA runs below the medial edge of the rectus abdominis muscle; the risk of damage to these vessels has led surgeons to opt for laparotomy to avoid any consequent massive haemorrhage (Lin and Grow 1999; Alkatout et al. 2015). The landmarks of the IEA and rectus abdominis muscle at the anterior superior iliac spine vary: 3.7–5.43 cm from midline and 5–6 cm from midline, respectively (Epstein et al. 2004; Rahn et al. 2010; Burnett et al. 2016; Joy et al. 2016, 2017). To prevent an IEA injury, various techniques have been proposed; the most common techniques are direct visualisation of the IEA, edge of the rectus abdominis muscle, and bladder dome via the primary port (Hurd et al. 2003).
Embolization of a large progressive symptomatic desmoid tumor in the rectus muscle of a female patient with multiple sclerosis: a case report
Published in Acta Chirurgica Belgica, 2018
I. Diebels, M. Blockhuys, P. Willemsen, Y. Pirenne
Embolization was performed one month later. Arterial access was achieved by puncture of the left common femoral artery by Seldinger technique. The sheath was advanced into the left external iliac artery after which the inferior epigastric artery was selectively catheterized. On CT-guidance and after contrast injection, the main artery of the tumor was identified and super selectively catheterized with a 0.021'' microcatheter. No pathological blush was observed. Embolization was performed by injection off 45–150 μm contourparticles in 0.8 ml lipiodol ultrafluid and 0.5 ml histoacryl transparent. Control angiography showed successful occlusion of the main artery of the tumor. The catheters and sheath were removed and the puncture site was closed by manual compression. The patient was discharged in good health the following day.
Embolization of a hemorrhaging abdominal plexiform neurofibroma
Published in Baylor University Medical Center Proceedings, 2020
Aaminah F. Azhar, Joseph Scott H. Bittle, Thomas J. Kwarcinski, Jonathan R. Hinshelwood
On angiogram, there was a hypertrophied right inferior epigastric artery with numerous vessels feeding the inferior aspect of the mass. This was subsequently embolized with Gelfoam (absorbable gelatin sponge). Follow-up angiogram demonstrated stasis of the distal branches of the right inferior epigastric artery. Angiography of the right internal mammary artery demonstrated a hypertrophic artery with a focal pseudoaneurysm (Figure 3a) at the site of active extravasation within the superior aspect of the mass. Using a microcatheter, the distal inferior mammary artery and pseudoaneurysm were catheterized and embolized using Gelfoam and microcoils. Completion angiogram demonstrated complete stasis without evidence of extravasation.