Location of Aortic Bifurcation
and Transverse Colon in
Postmenopausal Women:
Relevance to Laparoscopy
Ayman Al-Talib, M.D.
Research Fellow in Minimally Invasive Surgery
Department of Obstetrics and Gynecology
McGill University
Montreal, Quebec, Canada
Fawaz Alharbi, M.D.
Resident
Department of Radiology
McGill University
Montreal, Quebec, Canada
David Valenti, M.D.
Assistant Professor of Radiology
Department of Radiology
McGill University
Montreal, Quebec, Canada
Togas Tulandi, M.D., M.H.C.M.
Professor of Obstetrics and Gynecology
Milton Leong Chair in Reproductive Medicine
Department of Obstetrics and Gynecology
McGill University
Montreal, Quebec, Canada
This was a prospective study of postmenopausal women who underwent a computerized tomography (CT) examination of the abdomen and pelvis. We evaluated the location of the aortic bifurcation and transverse colon relative to the umbilicus at midline axis. Of 66 women, 24 were of normal weight, 23 were classified as overweight, and 19 as obese. The ages of the women in all groups were comparable. In the normal weight and overweight women, the mean location of the umbilicus was 0.6 cm ± 0.4 cm and 0.4 cm ± 0.3 cm cranial to the aortic bifurcation, respectively, and in obese women its mean location was 1.4 cm ± 0.5 cm caudal to the aortic bifurcation. In approximately half of the normal weight and overweight women, the umbilicus was located cranial to the aortic bifurcation, and in 62.2% of obese women it was located caudal to the aortic bifurcation. Compared to those with normal weight (0.3 cm ± 1.1 cm), the distance between umbilicus and transverse colon was greater in overweight (4.5 cm ± 1.2 cm) and obese women (7.1 cm ± 0.7 cm). In approximately one third of the normal weight women and over half of the overweight women, the umbilicus was located caudal to the transverse colon. In contrast, the umbilicus in 84.2% of the obese women was located caudal to transverse colon. There was a linear correlation between the distance of umbilicus and transverse colon distance and body mass index (BMI; r = 0.54, p < 0.0001). Regardless of the BMI, there was a wide variability whether the umbilicus was cranial or caudal to the aortic bifurcation or transverse colon. Similar to that in reproductive-aged women, in postmenopausal women the location of the aortic bifurcation and transverse colon varies. Proper insertion of the Veress needle and trocar is more important than a particular angle of insertion.
