The Journal of Minimally Invasive Gynecology
Volume 17, Issue 5 , Pages 583-586, September 2010

Variance in Abdominal Wall Anatomy and Port Placement in Women Undergoing Robotic Gynecologic Surgery

Presented at the 38th Annual American Association of Gynecologic Laparoscopists, Orlando, Florida, November 15–19, 2009.

  • Catherine A. Matthews, MD

      Affiliations

    • Department of Obstetrics and Gynecology, Virginia Commonwealth University Medical Center, Richmond
    • Corresponding Author InformationCorresponding author: Catherine A. Matthews, MD, Department of Obstetrics and Gynecology, Virginia Commonwealth University Medical Center,1250 E. Marshall St. Box 980034, Richmond, VA 23298.
    • ,
  • Christine M. Schubert, PhD

      Affiliations

    • Department of Biostatistics, Virginia Commonwealth University Medical Center, Richmond
    • ,
  • Ashley P. Woodward, MD

      Affiliations

    • Department of Obstetrics and Gynecology, Virginia Commonwealth University Medical Center, Richmond
    • ,
  • Edward J. Gill, MD

      Affiliations

    • Department of Obstetrics and Gynecology, Virginia Commonwealth University Medical Center, Richmond

Received 6 December 2009; accepted 23 April 2010. published online 02 July 2010.

Abstract 

Study Objectives

To estimate whether variability in the size and ratios of the lower and upper abdomen exist in women undergoing robotic gynecologic surgery and whether demographic variables are significantly associated, and to determine the association between abdominal wall dimensions and supraumbilical robotic port placement.

Design

Prospective cohort study (Canadian Task Force classification II-2).

Setting

University teaching hospital.

Patients

Seventy-eight women undergoing robotic surgery between May 2008 and March 2009.

Intervention

Measurements from the symphysis pubis to the umbilicus (lower abdomen), umbilicus to the xyphoid process (upper abdomen), and distance between the anterior superior iliac crests were obtained at surgery. A multiple linear regression model was created to determine the relationships between abdominal wall measurements, demographic variables, and need for supraumbilical robotic port placement.

Measurements and Main Results

Fifty-six white and 22 black women were enrolled. Mean lower abdominal length was significantly affected by body mass index (BMI) (p <.001) and race (p = .006), with white women having longer measurements (17.1 cm vs 15 cm). Mean lower abdominal width was independent of age (p = .95) or race (p = .98), but was significantly correlated with BMI (p <.001). Mean upper abdominal length correlated with BMI (p <.001) and age (p = .03) but not race (p = .13). Ratios of bottom to top were significantly affected by race (p = .002) and age (p = .008) but not BMI (p = .07). Adjustments to port placement above the umbilicus were made in 44 of the 74 women (59.5%). Those who required supraumbilical port placement had a significantly shorter mean (SD) distance between the symphysis pubis and the umbilicus (14.99 [1.36] vs 18.55 [2.21]; p <.001).

Conclusions

Significant variability in abdominal wall anatomy exists in women undergoing robotic gynecologic surgery, and the need for supraumbilical robotic port placement is common.

Keywords: Abdominal wall anatomy, Ethnic differences, Port placement, Robotic surgery

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 The authors have no commercial, proprietary, or financial interest in the products or companies described in this article.

PII: S1553-4650(10)00228-1

doi:10.1016/j.jmig.2010.04.008

The Journal of Minimally Invasive Gynecology
Volume 17, Issue 5 , Pages 583-586, September 2010

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