Use of the AccuVein AV400 during RARP: an infrared augmented reality device to help reduce abdominal wall hematoma

Abdominal wall hematoma (AWH) is a self-resolving, yet common complication from the insertion of trocars during laparoscopic surgery. Particularly, its appearance may increase patient anxiety and may reduce overall surgical satisfaction.

In a retrospective study analyzing data from 724 robot-assisted radical prostatectomy cases (RARP), trocar insertion sites were examined on postoperative day 7 with Foley removal for AWH. AWH was defined by a sizable collection of blood below the skin as a result of the surgery. The AccuVein AV400 system was utilized to generate real-time images of venous structures beneath the skin. Comparative outcomes were performed with a series of 114 men where the AccuVein AV400 device was applied over trocar insertion markings to help modify port placement.

The pre-incision imaging of the AccuVein system modified port placement in 74 of 114 cases (65%), and reduced AWH from 8.8% to 2.6% (p = 0.03) as compared to transabdominal illumination. Port placement adjustments were most prevalent in the lateral regions of the abdomen, prompting attention for lateral trocar insertion to avoid vessels such as the thoracoepigastric veins. Notably, the body mass index (BMI) of patients experiencing AWH who received the pre-incision imaging of AccuVein was significantly higher than patients receiving standard transabdominal illumination (34.2 and 27.9 kg/m² respectively; p = 0.02).

The AccuVein AV400 device appears to be an effective adjuvant for decreasing rates of AWH during lower abdominal wall trocar insertion, though its effectiveness is limited in patients with extreme BMI. Additionally, special attention should be directed towards trocar insertion in the lateral regions of the abdomen.