title: Umbilical center insertion method for initial trocar placement in pediatric laparoscopic surgery.
abstract: BACKGROUND
  For laparoscopic surgery in pediatric patients, the initial trocar insertion is usually made employing open laparotomy to avoid injury to the viscera. It is safe but somewhat time-consuming for establishing a pneumoperitoneum, and requires additional sutures for anchoring or preventing air leakage. We devised a new initial trocar insertion technique employing an umbilical center incision to shorten the surgical duration and improve the esthetic appearance.
  
  
  METHODS
  Four hundred and thirty-one pediatric patients were indicated for this umbilical center insertion method (UCM) at 2 pediatric surgical departments. Patients suspected of having umbilical lesions (except for umbilical hernia) or extensive bowel adhesions were excluded.
  
  
  RESULTS
  There was no complication associated with UCM. In almost all patients, a pneumoperitoneum was established within 1 minute. The wound was completely within the umbilical ring, and very satisfactory esthetically.
  
  
  CONCLUSIONS
  We consider UCM to be a safe and easy procedure, and acceptable method of initial trocar insertion for pediatric laparoscopic surgery.
authors.affiliation: Department of Pediatric Surgery, Osaka City General Hospital, 2-13-22 Miyakojimahondori, Miyakojima-ku, Osaka 534-0021, Japan. t-nakaoka@hospital.city.osaka.jp
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Nakaoka
authors.forename: Sadashige
authors.initials: S
authors.lastname: Uemura
authors.forename: Tatsuyuki
authors.initials: T
authors.lastname: Yoshida
authors.forename: Terutaka
authors.initials: T
authors.lastname: Tanimoto
authors.forename: Chizuka
authors.initials: C
authors.lastname: Shiokawa
authors.forename: Ken
authors.initials: K
authors.lastname: Harumoto
mesh_terms: D000293:Adolescent; D001062:Appendectomy / Q000295:instrumentation / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D008297:Male; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D012189:Retrospective Studies; D013525:Surgical Instruments; D014472:Umbilicus / Q000601:surgery*; D055815:Young Adult