[Arterial risks in celiosurgery]

It is important to recognize exceptional vascular events in celiosurgery because of their gravity. Most occur during pneumoperitoneal manoeuvres using a Palmer needle and rarely at the insertion of the first trocar. We performed a tomodensitometric study in 200 subjects free of abdominal pathology in order to determine the distance from the umbilicus to the aortic bifurcation, their projection over the spine and the superficial relations of the large vessels to the cutaneous umbilical cover. Generally, the projections of the umbilicus, and also the aortic bifurcation, lie over L4. The distance between the skin and the large retroperitoneal vesses is generally equal to one-third of the antero-posterior abdominal diameter. In thin subjects with a flat abdomen however, this distance may be smaller, even less than 3 cm. These findings emphasize the importance of "safety" manoeuvres during celiosurgery, especially during the learning period.