title: Paraumbilical peritoneal incision using the little finger in shunt operations for hydrocephalus: technical note.
abstract: BACKGROUND
  The shunt operation remains the standard procedure for the treatment of hydrocephalus. We describe a simple minilaparotomy method that involves perforation of the peritoneum with the surgeon's little finger.
  
  
  METHODS
  After placing a small paraumbilical incision at the skin and fascia, the little finger is introduced through the incision to perforate the pre-peritoneal fat and peritoneum. The finger should be inserted at a 30-45° angle to the horizontal plane to avoid injuring the underlying viscera and major blood vessels and to put sufficient shear force on the peritoneum. A catheter is inserted into the abdominal cavity after visual confirmation of proper perforation.
  
  
  CONCLUSIONS
  As the paraumbilical wound is not noticeable postoperatively due to the presence of the natural umbilical skin fold, this method yields a cosmetically appealing result.
authors.affiliation: Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan. yamahata-nsu@umin.net
authors.forename: H
authors.initials: H
authors.lastname: Yamahata
authors.forename: K
authors.initials: K
authors.lastname: Hirahara
authors.forename: T
authors.initials: T
authors.lastname: Tomosugi
authors.forename: K
authors.initials: K
authors.lastname: Tajitsu
authors.forename: T
authors.initials: T
authors.lastname: Hirayama
authors.forename: Y
authors.initials: Y
authors.lastname: Sadamura
authors.forename: K
authors.initials: K
authors.lastname: Eguchi
authors.forename: H
authors.initials: H
authors.lastname: Tokimura
authors.forename: K
authors.initials: K
authors.lastname: Arita
mesh_terms: D000368:Aged; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D007813:Laparotomy / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D010537:Peritoneum / Q000601:surgery*; D017287:Ventriculoperitoneal Shunt / Q000379:methods*