Abdominal subdivision and laparoscopic surgery: a new approach.

1. Abdominal
subdivision and
laparoscopic
surgery:
a new approach
Lorenzo Repetto, Salvatore Rocca Rossetti*
S.S.C.V.D. ” La Laparoscopia in Chirurgia ed in Urologia” - Molinette (Torino)
Già Direttore della Clinica Urologica dell’Università di Torino

2. Abdominal subdivision and laparoscopic
surgery: a new approach.
Subdivision of the anterior abdominal wall commonly used in
traditional surgery In laparotomic surgery we refer to incision
lines, whereas in laparoscopic technique we refer to incision
points.

3. In order to provide a simplified
standardized description of laparoscopic
procedures, we elaborated and modified,
on the basis of a proposal from prof.
Edmond Estour ( Clinique St.Joseph,
Valence ), a new topographic map of the
anterior abdominal wall to support a
descriptive approach to laparoscopic
surgery.
Esour Edmond - Essai de cartographie parietale
abdominal en coelio-chirurgie
J- coelio.chirur. n.2 - 1992, 3-6

4. Abdominal subdivision and laparoscopic
surgery: a new approach.
Therefore a map of the abdominal wall facing this
different approach has to be delineated.

5. On the abdominal field a perimeter is
outlined and 12 sectors are indicated in
the hexagonal area covering the
abdominal wall; in each sector three
center-peripheral areas are indicated,
drawing an umbilicus-centered map.
In addition, we indicated the steps in the
abdominal incisions and the diameter of
the trocars employed.
Or example: our approach in the left
nephrectomy
1(10) 1c V open laparoscopy
2(5) 3a
3(5-12) 4b

6. Abdominal subdivision and laparoscopic
surgery: a new approach.
On the anterior abdominal wall a xiphopubic midline can
be drawn
Two lateral lines connecting the anterior superior iliac
spine to the lower costal arch are traced

7. Abdominal subdivision and laparoscopic
surgery: a new approach.
A xipho-costal and a pubo-spine line on each side are
then drawn so that the hexagonal field covering the
abdominal wall is outlined. A transumbilical
horizontal line connects the two lateral lines of the
perimeter

8. Abdominal subdivision and laparoscopic
surgery: a new approach.
A periumbilical ring is delineated.
Starting from the intersection of the
transumbilical and the xiphopubic line two
radial lines are drawn in each quadrant of the
hexagonal field.
12 radial lines and 12 points on the perimeter are
thus identified.

9. Abdominal subdivision and laparoscopic
surgery: a new approach.
The points on the perimeter are now indicated
in a clockwise sequence as 1. 2, 3 etc. and the
lines 1, 2, 3, etc now delineate zone 1, 2, 3, etc.

10. Abdominal subdivision and laparoscopic
surgery: a new approach.
On each radial line connecting point 0 to the perimeter
three points on equal segments are indicated: the
innermost as point a , the intermediate as point b , the
outer as point c.

11. Abdominal subdivision and laparoscopic
surgery: a new approach.
The points a on each line are now connected, as
well as points b and points c.

12. Abdominal subdivision and laparoscopic
surgery: a new approach.
The points a on each line are now connected,
as well as points b and points c.

13. Abdominal subdivision and laparoscopic
surgery: a new approach.
In the Umbelical zone
Us ombelicale superior
Ui ombelicale inferiore
Udx ombelicale destra
Osx ombelicale sinistra

14. Abdominal subdivision and laparoscopic
surgery: a new approach.
The time sequence of the incisions will be
indicated as 1, 2, 3, etc.
The size of the trocar ( 5 = 5mm, 10 = 10mm, etc
) will be indicated in brackets, following the
incision step.
“ V “ will indicate the videolaparoscopic
registration…..(videotelecamera)

15. Una Proposta di Topografia Addominale da
Utilizzare in Chirurgia Laparoscopica
1(10) 1c V open laparoscopy
indicates incision 1 using a 10mm trocar in the 1c zone
introducing the optical device through the same
incision.
2(5) 2a
indicates that a second trocar (5 mm) was introduced
in line 2 in position a
3(5-12) 4b
indicates that a fourth trocar 5-12 mm in diameter was
introduced in position b.

16. Abdominal subdivision and laparoscopic surgery
Repetto – Rocca Rossetti