title: The umbilical Benz incision for reduced port surgery in pediatric patients.
abstract: OBJECTIVE
  For reduced port surgery in pediatric patients, the initial umbilical incision plays an important role in both functional ability and cosmetic impact. Larger umbilical incisions enable better manipulation of forceps, extraction of larger surgical specimens, and easier exteriorization of the intestine for anastomosis. We have pursued an incision of the small pediatric umbilicus that allows for enlargement of the orifice of the abdominal opening with preservation of the natural umbilical profile. This article aims to present a new umbilical incision technique and describe the outcomes.
  
  
  METHODS
  We devised a new umbilical incision technique for reduced port surgery in pediatric patients. Our incision is made in an inverted Y shape (Benz incision), allowing for access port device insertion. The Benz incision technique was applied between November 2010 and May 2014 and was retrospectively studied.
  
  
  RESULTS
  Seventy-five patients underwent Benz incisions. The median age of all patients was 6 years 6 months (range, 26 days to 18 years), and the median body weight was 21.7 kg (range, 3.1-54.3 kg). Benz incisions were applied for various procedures, including reduced port surgery with hepaticojejunostomy for congenital biliary dilatation, portojejunostomy for biliary atresia, Meckel diverticulectomy, tumor resection, varicocelectomy, cholecystectomy, splenectomy, ileus surgery, ileocecal resection, and total colectomy. All patients were successfully treated, without a significant increase in operating time or severe complications. The cosmetic profile of the umbilicus was maintained after surgery.
  
  
  CONCLUSIONS
  The Benz incision is a feasible, effective, and scarless approach for reduced port surgery in pediatric patients whose umbilical rings are too small for the conventional approach.
authors.affiliation: Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan.
authors.forename: Hizuru
authors.initials: H
authors.lastname: Amano
authors.affiliation: Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Uchida
authors.affiliation: Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawashima
authors.affiliation: Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan.
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Deie
authors.affiliation: Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Naruhiko
authors.initials: N
authors.lastname: Murase
authors.affiliation: Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Makita
authors.affiliation: Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Yokota
authors.affiliation: Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan.
authors.forename: Yujiro
authors.initials: Y
authors.lastname: Tanaka
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D013505:Digestive System Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D008297:Male; D061646:Operative Time; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D014472:Umbilicus / Q000601:surgery*
keywords: Pediatric surgery; Reduced port surgery; Transumbilical laparoscopic surgery
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