proposed abdominal topography

Abdominal Abdominal subdivision and subdivision and

laparoscopic laparoscopic surgery: surgery:

a new approacha new approach

Lorenzo Repetto, Salvatore Rocca Rossetti* 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

Abdominal subdivision and laparoscopic Abdominal subdivision and laparoscopic surgery: a new approach.surgery: a new approach.

Subdivision of the anterior abdominal wall commonly used in traditional surgery In laparotomic surgery we refer to incision In laparotomic surgery we refer to incision lines, whereas in laparoscopic technique we refer to incision lines, whereas in laparoscopic technique we refer to incision points. points.

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


Therefore a map of the abdominal wall facing this Therefore a map of the abdominal wall facing this different approach has to be delineated.different approach has to be delineated.

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 laparoscopy2(5) 3a3(5-12) 4b


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


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


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.


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.


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.


The points a on each line are now connected, as well as points b and points c.


The points a on each line are now connected, The points a on each line are now connected, as well as points b and points c.as well as points b and points c.


In the UmbelicalIn the Umbelical zone zone UsUs ombelicale superior

Ui Ui ombelicale inferioreUdx Udx ombelicale destra

Osx Osx ombelicale sinistraombelicale sinistra


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)

Una Proposta di Topografia Addominale da Una Proposta di Topografia Addominale da Utilizzare in Chirurgia LaparoscopicaUtilizzare in Chirurgia Laparoscopica

1(10) 1c V open laparoscopyindicates 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) 4bindicates that a fourth trocar 5-12 mm in diameter was

introduced in position b.

Abdominal subdivision and laparoscopic surgeryAbdominal subdivision and laparoscopic surgery

Repetto – Rocca RossettiRepetto – Rocca Rossetti

proposed abdominal topography

Health & Medicine

abdominal subdivision

laparoscopic surgery

abdominal field

adescriptive approach

different approach

new approach lorenzo

points b

traditional surgery