title: "Spaghetti maneuver": a useful tool in pediatric laparoscopy - our experience.
abstract: OBJECTIVE
  The laparoscopic "Spaghetti Maneuver" consists in holding an organ by its extremity with a grasper and rolling it up around the tool to keep the organ stable and facilitate its traction within a small space. We describe our experience with the "Spaghetti Maneuver" in some minimally invasive procedures.
  
  
  METHODS
  We successfully adopted this technique in 13 patients (5F : 8M) aged between 6 and 14 years (average age, 10) on whom we performed 7 appendectomies, 2 ureteral reimplantation and 4 cholecystectomies. In all cases, after the first steps, the appendix, the gallbladder and the ureter were rolled around the grasper and easily isolated; hemostasis was thus induced and the organ was mobilized until removal during cholecystectomy and appendectomy, and before the reimplantation in case of ureteral reimplantation.
  
  
  RESULTS
  We found that this technique facilitated significantly the acts of holding, isolating and removing, when necessary, the structures involved, which remained constantly within the visual field of the operator. This allowed a very ergonomic work setting, overcoming the problem of the "blind" zone, which represents a dangerous and invisible area out of the operator's control during laparoscopy. Moreover the isolation maneuvers resulted easier and reduced operating time.
  
  
  CONCLUSIONS
  We think that this technique is easy to perform and very useful, because it facilitates the dissection of these organs, by harmonizing and stabilizing the force of traction exercised.
authors: Department of Pediatric Surgery, Second University of Naples, Italy. antonio.marte@unina2.it
authors: Antonio
authors: A
authors: Marte
authors: Silvia
authors: S
authors: Cavaiuolo
authors: Lucia
authors: L
authors: Pintozzi
authors: Maurizio
authors: M
authors: Prezioso
authors: Fabiano
authors: F
authors: Nino
authors: Sandra
authors: S
authors: Coppola
authors: Micaela
authors: M
authors: Borrelli
authors: Pio
authors: P
authors: Parmeggiani
mesh_terms: D000293:Adolescent; D001062:Appendectomy / Q000379:methods; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D002764:Cholecystitis / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014515:Ureteral Diseases / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods