title: Transumbilical cord access (TUCA) for laparoscopy in infants and children: simple, safe and fast.
abstract: OBJECTIVE
  We herein report a case series evaluating the safety and complication rate of transumbilical cord access (TUCA) for pediatric laparoscopic surgery.
  
  
  METHODS
  Data were collected for 556 infants and children. Access into the abdominal cavity was gained via a transverse infraumbilical stab incision passing the fibrotic umbilical cord remnant. Ninety-two infants underwent laparoscopic pyloromyotomy (LPM), 159 female infants underwent herniorrhaphy (LHR) and 309 infants underwent appendectomy (LAP). Of the total operations, 70 % were performed by board-certified surgeons and 30 % were performed by non-board-certified surgeons. The median time of follow-up was 24 months.
  
  
  RESULTS
  No cases of acute severe bleeding or organ laceration were noted. TUCA-related complications were observed in nine patients (1.6 %). Omphalitis and persistent wound secretion were detected in eight children and foreign bodies consisting of cyanoacrylate were removed from three of these patients. Meanwhile, umbilical pain leading to surgical revision was observed in one child, and eight umbilical hernias were repaired during the TUCA procedures. No signs of postoperative incisional hernia were recorded.
  
  
  CONCLUSIONS
  TUCA is a safe and comfortable access method for pediatric laparoscopic surgery in various age groups. This method is easy to learn and can be quickly and safely performed in the vast majority of children.
authors.affiliation: Department of Pediatric Surgery, Catholic Foundation Marienhospital Herne, Ruhr-University of Bochum, Widumer Str. 8, 44627, Herne, Germany. ralf-bodo.troebs@marienhospital-herne.de.
authors.forename: Ralf-Bodo
authors.initials: RB
authors.lastname: Tröbs
authors.affiliation: Department of Pediatric and Adolescent Surgery, Klinikum Der Stadt Köln, Amsterdamer Str. 59, 50735, Cologne, Germany. rvahdad@aol.com.
authors.forename: M Reza
authors.initials: MR
authors.lastname: Vahdad
authors.affiliation: Department of Pediatric Surgery, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany. grigore.cernaianu@uksh.de.
authors.forename: Grigore
authors.initials: G
authors.lastname: Cernaianu
mesh_terms: D000293:Adolescent; D001062:Appendectomy / Q000379:methods; D002648:Child; D002675:Child, Preschool; D003487:Cyanoacrylates; D013505:Digestive System Surgical Procedures / Q000193:education / Q000379:methods; D004501:Education, Medical; D005260:Female; D005500:Follow-Up Studies; D059685:Herniorrhaphy / Q000379:methods; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control; D011708:Pylorus / Q000601:surgery; D012189:Retrospective Studies; D014470:Umbilical Cord / Q000601:surgery*
chemical_list: D003487:Cyanoacrylates
keywords: Cyanoacrylate; Open laparoscopy; Pediatric surgical training; Umbilical cord