Vasculature of the Anterior Abdominal Wall and Surface Anatomy of the Liver and Stomach: Considerations for Minimal Access Surgeries in Neonates

Background: Minimal access surgeries are growing more common in neonatal care, but the risk of accidental injury to abdominal wall blood vessels remains a concern. This risk is increased by limited precise anatomical data specific to neonates. Therefore, this study aimed to quantitatively map the superficial and deep blood vessels of the neonatal anterior abdominal wall concerning important surgical landmarks to develop evidence-based recommendations for safer laparoscopic port placement. Methods: Thirty formalin-fixed low-birth-weight neonatal body donations (≤4 weeks old) were dissected. An anatomical grid based on palpable landmarks—including the umbilicus, xiphoid process, and anterior superior iliac spines—was utilised to measure distances to the nearest vessels via digital image analysis. In situ topography of the liver, stomach, and umbilical vessels was also documented. Results: A midline corridor of reduced vascular density was identified; minimum circumferential distances to deep vessels above the umbilicus averaged 6.84–6.88 mm. Conversely, lateral regions were highly vascular, particularly at or below the transumbilical plane, with distances to deep vessels as short as 1.08 ± 0.83 mm. The liver and stomach extended significantly below the costal margin (averaging 20.61 ± 8.29 mm and 34.18 ± 14.44 mm, respectively). Conclusions: The results establish an anatomical foundation for using the reduced vascular midline for port placement and highlight the importance of inserting secondary lateral ports under direct visualisation.