Umbilical Center Insertion Method for Initial Trocar Placement in Pediatric Laparoscopic Surgery

Background For laparoscopic surgery in pediatric patients, the initial trocar insertion is usually made employing open laparotomy to avoid injury to the viscera. It is safe but somewhat time­ consuming for establishing a pneumoperitoneum, and requires additional sutures for anchoring or preventing air leakage. We devised a new initial trocar insertion technique employing an umbilical center incision to shorten the surgical duration and improve the esthetic appearance. Patients and Methods Four hundred and thirty-one pediatric patients were indicated for this umbilical center insertion method (UCM) at 2 pediatric surgical departments. Patients suspected of having umbilical lesions (except for umbilical hernia) or extensive bowel adhesions were excluded. Results There was no complication associated with UCM. In almost all patients, a pneumo­ peritoneum was established within 1 minute. The wound was completely within the umbilical ring, and very satisfactory esthetically. Discussion We consider UCM to be a safe and easy procedure, and acceptable method of initial trocar