Anterior Abdominal Wall Landmarks for Port Placement

Expansion

Umbilical (primary) port

• The umbilicus is the thinnest part of the abdominal wall, with all layers fused - hence its use for primary access
• Immediately beneath lie the aorta, the inferior vena cava and the iliac vessels, especially in thin patients where the distance may be only a few centimetres
• The aortic bifurcation is at L4, just above the umbilical level

Lateral ports

• The inferior epigastric vessels run up behind rectus abdominis, lateral to the umbilical folds. Placing ports lateral to the rectus sheath avoids them
• The superficial epigastric vessels can be seen by transillumination; the inferior epigastrics can be seen laparoscopically from within

Other risks are bowel injury from adhesions at previous scars, hence alternative entry at Palmer’s point in the left upper quadrant, and port site hernia, which is why fascial defects of 10 mm or more are closed.