Identification of safe trocar insertion sites guided by ultrasonography to minimize epigastric vessel injuries in pediatric laparoscopic procedures.

Background & aim: In pediatric laparoscopy, deep epigastric vessels are among the structures most frequently injured during trocar insertion, potentially leading to significant bleeding. Although the anatomical course of these vessels has been described in adults, a systematic ultrasonographic mapping in children is lacking. The aim of this study was to determine the location of deep epigastric vessels in pediatric patients using Doppler ultrasonography and to identify safe zones for trocar placement. Methods: This study involved 90 pediatric patients who underwent color doppler ultrasound evaluation of the deep epigastric vessels before laparoscopic surgery. The deep epigastric vessels were identified at 5 equidistant levels between the xiphoid process and the symphysis pubis. Bilateral measurements of the distance of the epigastric vessels from the midline were taken at each level. Predictive analysis utilized a linear mixed model with maximum likelihood estimation. Results: The mean distances of the deep epigastric vessels to the midline at different levels in the abdominal region were 6.18 ± 0.7 cm at the right pubic symphysis, 4.64 ± 0.6 cm from the umbilicus, and 3.21 ± 0.5 cm at the level of the xiphoid. On the left, it was 6.46 ± 0.69 cm from the pubic symphysis, 4.64 ± 0.6 cm from the umbilicus, and 3.19 ± 0.5 cm at the level of the xiphoid. Conclusion: Significant variation in the distance of deep epigastric vessels from the midline in pediatric patients was observed, with no significant differences between male and female children. Consistent with the existing literature, the findings identify relatively safe avascular areas for lateral trocar placement in the pediatric population.