title: UREKA: umbilical ring easy kannula access.
abstract: OBJECTIVE
  Standard techniques of laparoscopic access involve creating an abdominal wall defect and can result in complications. We describe the umbilical ring easy kannula access (UREKA) technique, evaluating safety and a decrease in complications related to port placement.
  
  
  METHODS
  UREKA is performed via a supra- or infraumbilical incision followed by circumferential dissection of the umbilical stalk. The umbilical skin is dissected free from the fascia, exposing the umbilical ring. Pneumoperitoneum is established either before or after placement of a dilating port through the open ring. We reviewed all laparoscopic procedures performed by one pediatric surgeon over 14 months using UREKA.
  
  
  RESULTS
  Ninety-four patients underwent laparoscopic surgery with initial port placement via UREKA. Appendectomy (n=57) was the most common procedure, followed by fundoplication (15) and cholecystectomy (10). No intestinal, solid organ, vascular, or bladder injuries related to port placement occurred. The only postoperative complication was a superficial wound infection in a 135-kg patient following cholecystectomy, treated successfully with oral antibiotics alone.
  
  
  CONCLUSIONS
  The umbilical ring persists to some degree in all pediatric patients and provides a safe portal of entry for laparoscopic surgery. UREKA has few complications and is a straightforward, reproducible technique for gaining initial laparoscopic access.
authors: Grand Rapids Medical Education Partners/Michigan State University Surgery Residency, Grand Rapids, Michigan, USA.
authors: Jared W
authors: JW
authors: Carlson
authors: James M
authors: JM
authors: DeCou
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004210:Dissection / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D014472:Umbilicus / Q000601:surgery*