Chaves KF, Apple AN, Johnson JC, Jesse NJ, Yunker AC. Abdominal Wall Thickness at Palmer's Point and Distance to Adjacent Structures Across the Body Mass Index Spectrum.
J Minim Invasive Gynecol 2022;
29:848-854. [PMID:
35306223 DOI:
10.1016/j.jmig.2022.03.007]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE
Studies delineating left upper quadrant (LUQ) anatomy across a range of body mass indices are lacking. We aimed primarily to compare, between non-obese and obese women, abdominal wall thickness and the distance from the LUQ to key structures. Additionally, we aimed to characterize LUQ anatomy in underweight women.
DESIGN
A retrospective cohort study.
SETTING
A tertiary academic medical institution.
PATIENTS
Sixty women (30 non-obese, 30 obese) age 18 and older who underwent abdominal imaging from 10/1/2018 through 12/31/2018.
INTERVENTIONS
Computed tomography imaging of the chest, abdomen, and pelvis.
MEASUREMENTS AND MAIN RESULTS
Abdominal wall thickness at the LUQ was significantly greater in obese (4.3 ± 1.7 cm) as compared to non-obese patients (2.4 ± 1.7 cm) (p<.001), as were distances to all key structures (aorta, vena cava, spleen, stomach, pancreas, liver, left kidney, pelvis) (p≤.02). On average, all structures, with the exception of stomach and liver, were >10 cm (the length of a typical insufflation needle) away from the LUQ insertion point in obese women. In underweight women, the aorta, spleen, stomach, pancreas, and liver were all within 10 cm of the LUQ insertion point. Within the obese and non-obese group, abdominal wall thickness at the LUQ was significantly greater than at the umbilicus (p<.001). Body mass index (BMI) was more strongly correlated with abdominal wall thickness at the LUQ (r=0.84, p<.001) than at the umbilicus (r=.69, p<.001) (p=.007 for comparison).
CONCLUSION
This study highlights special anatomic considerations for LUQ access in obese and underweight patients. In obese women, abdominal wall thickness may be greater at this site than at the umbilicus and the liver and stomach remain within reach of an insufflation needle. The increased working distance from the LUQ to the pelvis in obese patients may necessitate specialized instruments if this site is used during surgery. In underweight women, the aorta, in addition to many other structures, is within reach of commonly used entry devices.
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