1 Nov 2016Review
Safe introduction of ancillary trocars in gynecological surgery: the “yellow island” anatomical landmark
Salvatore Vitale 1Nicola Gasbarro 2Antonio Laganà 1Fabrizio Sapia 3Agnese Rapisarda 3Gaetano Valenti 3Maria Trovato 3Diego Rossetti 4Benito Chiofalo 1Giuseppina Barrasso 3Andrea Tinelli 5Francesco Corrado 1
Affiliations
Article Info
1 Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
2 Independent Researcher, Pozzuoli (Napoli), Italy
3 Department of Medical Surgical Specialties, Gynecology and Obstetrics Unit, University of Catania, Italy
4 Department of Maternal and Child Health, Gavardo Hospital, Brescia, Italy
5 Department of Gynecology and Obstetrics, Division of Experimental Endoscopic Surgery, Imaging, Minimally Invasive Therapy and Technology, Vito Fazzi Hospital, Lecce, Italy
Ann. Ital. Chir., 2016, 87(6), 608-611;
Published: 1 Nov 2016
Copyright © 2016 Annali Italiani di Chirurgia
This work is licensed under a Creative Commons Attribution 4.0 International License.
Abstract
AIM: This technical note aims to suggest a safe introduction of ancillary trocars in gynaecological surgery, in order to prevent inferior epigastric artery damage. MATERIAL OF STUDY: We performed a narrative overview, synthesizing the findings of literature retrieved from searches of computerized databases. RESULTS: Among the different techniques, the identification of the “yellow island” as anatomical landmark seems to be a useful aid to avoid complication. This particular landmark is identified taking the lateral third of a line between the anterior superior iliac spine and the umbilicus as reference points, by a subperitoneal accumulation of adipose tissue located in that area. DISCUSSION: “Yellow island” could be considered a safe place for trocars introduction because epigastric artery never runs there, even in patients with particular anatomical variants. This technique is particularly useful in obese patients, in which “yellow island” appears to be more evident respect to lean ones. Furthermore, the use of “open” trocars insertion may reduce the possibility of epigastric artery lesions respect to “Verres needle technique”. CONCLUSION: The identification of the “yellow island” anatomical landmark could be considered an useful aid for the safe introduction of ancillary trocars in gynaecological surgery.
Keywords
- Gynaecology
- Laparoscopic surgery
- Trocars placement