Preoperative Ultrasound Assessment of Abdominal Wall Thickness and Vascular Proximity at the Umbilical Region.

Abstract

Objective: To quantify abdominal wall thickness and distances to the superior mesenteric artery (SMA) and major retroperitoneal vessels using standardized transabdominal ultrasound with color Doppler.

Study design: Prospective observational study conducted at a single high-volume minimally invasive gynecologic surgery center. Consecutive patients scheduled for laparoscopic surgery underwent preoperative ultrasound mapping of abdominal wall thickness and skin-to-vessel distances to the aorta, IVC, and SMA. Primary outcomes were abdominal wall thickness and skin-to-vessel distances. Secondary outcomes included comparison of measurements before and after anesthesia and across BMI categories (<20, 20-24.9, 25-29.9, ≥30 kg/m²).

Results: A total of 193 patients were enrolled. Mean skin-to-vessel distances were: aorta 5.73 cm (SD 2.11), IVC 5.72 cm (SD 2.15), and SMA 4.34 cm (SD 1.50). Abdominal wall thickness and skin-to-vessel distances increased significantly across BMI categories (all p < 0.001). Among patients with paired measurements (n = 81), no significant differences were observed before versus after anesthesia.

Conclusions: Preoperative transabdominal ultrasound with color Doppler is a feasible, noninvasive tool for measuring abdominal wall thickness and vascular proximity across BMI categories, with stability before and after anesthesia supporting its reliability as an office-based assessment. These normative data provide a foundation for future studies evaluating whether individualized preoperative ultrasound can improve laparoscopic entry safety.