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Anatomy of the left upper quadrant for cannula insertion
P K Tulikangas1, A Nicklas, T Falcone
1Department of Minimally Invasive Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Summary
Left upper quadrant (LUQ) anatomy in women varies with body mass index (BMI). Obese women with higher BMIs have organs further from the LUQ insertion site, suggesting safety, but caution is advised for those with enlarged livers or spleens.
Area of Science:
- Abdominal anatomy
- Surgical safety
Background:
- Understanding the anatomical variations in the left upper quadrant (LUQ) is crucial for safe surgical procedures.
- Body Mass Index (BMI) can influence the spatial relationships of abdominal organs.
Purpose of the Study:
- To delineate the anatomical characteristics of the LUQ in women across a spectrum of body mass indexes.
- To assess the safety of LUQ as an insertion site for laparoscopic procedures based on patient BMI.
Main Methods:
- Retrospective review of computed tomographic (CT) scans and medical records from a tertiary care center.
- Analysis included 63 women over 18 years old, with exclusions for contraindications or incomplete data.
Main Results:
- The liver and stomach were identified as the organs closest to the LUQ insertion site.
- A positive correlation was observed between higher BMI and increased distance between abdominal structures and the LUQ insertion site.
- Subcutaneous fat was significantly less at the LUQ insertion site compared to the umbilicus.
Conclusions:
- The LUQ is likely safe for cannula insertion in obese women due to increased organ distance and reduced subcutaneous fat.
- Hepatomegaly or splenomegaly are contraindications for LUQ cannula insertion.
- Gastric drainage is recommended prior to LUQ cannula insertion due to the proximity of the stomach.