title: A new technique applicable to pediatric laparoscopic surgery: abdominal wall 'area lifting' with subcutaneous wiring.
abstract: BACKGROUND
  Recently, the authors developed a unique method of laparoscopic surgery without pneumoperitoneum: "area lifting of the abdominal wall with subcutaneous wiring."
  
  
  METHODS
  In this gasless procedure, the anterior abdominal wall is pulled upward by a pair of wires placed subcutaneously and held by thick sutures for "hanger lifting." Simultaneous lifting of a pair of subcutaneous wires across the abdomen, produces a wide, roof-shaped intraabdominal space sufficient for laparoscopic surgical procedures. The practical aspects of this gasless technique, as well as the authors' limited experience with this method in 24 children, ranging from 8 days to 15 years of age is presented. These children have had various pathologies including splenomegaly, rectal prolapse, ovarian cyst, gall stone, adrenal neuroblastoma, and abdominal wall abscess.
  
  
  CONCLUSIONS
  Gasless laparoscopic surgery with double subcutaneous wiring is safe for children including neonates and those with respiratory compromise because all operative procedures are performed under normal abdominal pressure. Because of the highly elastic abdominal wall musculature inherent in children, this selective area lifting of abdominal wall creates a relatively larger peritoneal volume than in adults.
authors.affiliation: Department of Pediatric Surgery, Japanese Red Cross Medical Center, Tokyo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Yokomori
authors.forename: K
authors.initials: K
authors.lastname: Terawaki
authors.forename: Y
authors.initials: Y
authors.lastname: Kamii
authors.forename: K
authors.initials: K
authors.lastname: Obana
authors.forename: K
authors.initials: K
authors.lastname: Hashizume
authors.forename: T
authors.initials: T
authors.lastname: Hoshino
authors.forename: D
authors.initials: D
authors.lastname: Hashimoto
mesh_terms: D000009:Abdominal Muscles / Q000601:surgery; D000015:Abnormalities, Multiple / Q000175:diagnosis / Q000601:surgery*; D000293:Adolescent; D001659:Biliary Tract / Q000002:abnormalities; D002648:Child; D002675:Child, Preschool; D004066:Digestive System Diseases / Q000601:surgery; D004869:Equipment Safety; D005260:Female; D006058:Gonadal Disorders / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D012680:Sensitivity and Specificity; D013525:Surgical Instruments; D013536:Suture Techniques; D013737:Testis / Q000002:abnormalities