Top

Surgery Today

Published in:

Open Access 01-02-2016 | Original Article

Transumbilical cord access (TUCA) for laparoscopy in infants and children: simple, safe and fast

Authors: Ralf-Bodo Tröbs, M. Reza Vahdad, Grigore Cernaianu

Published in: Surgery Today | Issue 2/2016

Abstract

Purpose

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.

Levitt MA, Tantoco JG. Instruments for laparoscopy and thoracoscopy access. In: Najmaldin A, editor. Operative endoscopy and endoscopic surgery in infants and children. London: Hodder Arnold; 2005. p. 38–40.

Schier F, Turial S. Laparoscopy in children. 2nd ed. Heidelberg: Springer; 2013. p. 12–5.CrossRef

Hasson HM. A modified instrument and method for laparoscopy. Am J Obstet Gynecol. 1971;110:886–7.PubMed

Schleef J. Complications of endoscopic surgery in infants and children. In: Bax MA, Georgeson KE, Rotheberg SS, Valla JS, Yeung CK, editors. Endoscopic surgery in infants and children. Berlin: Springer Verlag; 2008. p. 60–9.

Poppas DP, Bleustein CB, Peters CA. Box stitch modification of Hasson technique for pediatric laparoscopy. J Endourol. 1999;13:447–50. doi:10.1089/end.1999.13.447.CrossRefPubMed

Schäfer M, Lauper M, Krähenbühl L. Trocar and Veress needle injuries during laparoscopy. Surg Endosc. 2001;15:275–80. doi:10.1007/s004640000337.CrossRefPubMed

Endo M, Watanabe T, Nakano M, Yoshida F, Ukiyama E. Laparoscopic completely extraperitoneal repair of inguinal hernia in children: a single-institute experience with 1,257 repairs compared with cut-down herniorrhaphy. Surg Endosc. 2009;23:1706–12. doi:10.1007/s00464-008-0300-7.PubMedCentralCrossRefPubMed

Ahmad G, Duffy JM, Philips K, Watson A. Laparoscopic entry techniques. Cochrane Database Syst Rev. 2008; 2:CD006583.

Silay MS, Tepeler A, Sancaktutar AA, Kilincaslan H, Altay B, Erdem MR, et al. The all-seeing needle instead of the Veress needle in pediatric urologic laparoscopy. J Endourol. 2013;27:1376–80. doi:10.1089/end.2013.0054.CrossRefPubMed

10.

Yanke BV, Horowitz M. Safety of the Veress needle in pediatric laparoscopy. J Endourol. 2007;21:695–7. doi:10.1089/end.2006.9950.CrossRefPubMed

11.

Passerotti CC, Nguyen HT, Retik AB, Peters CA. Patterns and predictors of laparoscopic complications in pediatric urology: the role of ongoing surgical volume and access techniques. J Urol. 2008;180:681–5. doi:10.1016/j.juro.2008.04.042.CrossRefPubMed

12.

Peters CA. Complications in pediatric urological laparoscopy: results of a survey. J Urol. 1996;155:1070–3. doi:10.1016/S0022-5347(01)66394-8.CrossRefPubMed

13.

Mayol J, Garcia-Aguilar J, Ortiz-Oshiro E, De-Diego Carmona JA, Fernandez-Represa JA. Risks of the minimal access approach for laparoscopic surgery: multivariate analysis of morbidity related to umbilical trocar insertion. World J Surg. 1997;21:529–33. doi:10.1007/PL00012281.CrossRefPubMed

14.

Hashizume M, Sugimachi K. Needle and trocar injury during laparoscopic surgery in Japan. Surg Endosc. 1997;11:1198–201. doi:10.1007/s004649900568.CrossRefPubMed

15.

Scott-Conner CEH, Dawson DL. Laparoscopy: principles of access and exposure. In: Scott-Conner CEH, Dawson DL, editors. Operative anatomy. 3rd ed. Philadelphia: Lippincott Williams and Wilkins/Wolters Kluwer; 2009. p. 292–301.

16.

Moberg AC, Petersson U, Montgomery A. An open access technique to create pneumoperitoneum in laparoscopic surgery. Scand J Surg. 2007;96:297–300.PubMed

17.

Lal P, Sharma R, Chander R, Ramteke VK. A technique for open trocar placement in laparoscopic surgery using the umbilical cicatrix tube. Surg Endosc. 2002;16:1366–70. doi:10.1007/s00464-001-8308-2.CrossRefPubMed

18.

Fathi AH, Soltanian H, Saber AA. Surgical anatomy and morphologic variations of umbilical structures. Am Surg. 2012;78:540–4.PubMed

19.

Oh CS, Won HS, Kwon CHD, Chung IH. Morphologic variations of the umbilical ring, umbilical ligaments and ligamentum teres hepatis. Yonsai Med J. 2008;49:1004–7.CrossRef

20.

Esposito C. Transumbilical open laparoscopy: a simple method of avoiding complications in pediatric surgery. Pediatr Surg Int. 1997;12:226–7. doi:10.1007/BF01350014.CrossRef

21.

Nakaoka T, Uemura S, Yoshida T, Tanimoto T, Shiokawa C, Harumoto K. Umbilical center insertion method for initial trocar placement in pediatric laparoscopic surgery. Osaka City Med J. 2010; 56:21–6 (abstract).

22.

Bonjer HJ, Hazebroek EJ, Kazemier G, Giuffrida MC, Meijer WS, Lange JF. Open versus closed establishment of pneumoperitoneum in laparoscopic surgery. Br J Surg. 1997;84:599–602.CrossRefPubMed

23.

Borgatta L, Gruss L, Barad D, Kaali SG. Direct trocar insertion vs. Veress needle use for laparoscopic surgery: a French survey of 103 852 operations. J Reprod Med. 1990;35:891–4.PubMed

24.

Cogliandodlo A, Manganaro T, Saitta FP, Micali B. Blind vs. open approach to laparoscopic cholecystectomy: a randomized study. Surg Laparoscop Endosc. 1998;8:853–5.

25.

Andersen BR, Kallehave FL, Andersen HK. Antibiotics versus placebo for prevention of postoperative infection after appendectomy. Cochrane Database Syst Rev. 2001;20:CD001439. doi: 10.1002/14651858.CD001439.

26.

Sohn M, Hoffmann M, Hochrein A, Buhr HJ, Lehmann KS. Laparoscopic appendectomy is safe: influence of appendectomy technique on surgical-site infections and intra-abdominal abscesses. Surg Laparosc Endosc Percut Tech. 2014 (epub ahead of print).

27.

Li B, Chen WB, Wang SQ, Wang YB. Single-site umbilical laparoscopic pyloromyotomy in neonates less than 21 days old. Surg Today. 2015;45:29–33. doi:10.1007/s00595-014-0854-z.CrossRefPubMed

28.

Kimura T, Yamauchi K, Ihara Y, Sawai T, Kosumi T, Yonekura T. Single-site laparoscopic herniorrhaphy using needle instruments for inguinal hernias in children: a novel technique. Surg Today. 2012;42:100–3. doi:10.1007/s00595-011-0020-9.CrossRefPubMed

29.

Yamazaki M, Yasuda H, Koda K. Single-incision laparoscopic cholecystectomy: a systematic review of methodology and outcomes. Surg Today 2014 Mai 22. doi:10.1007/s00595-014-0908-2.

Title: Transumbilical cord access (TUCA) for laparoscopy in infants and children: simple, safe and fast
Authors: Ralf-Bodo Tröbs
M. Reza Vahdad
Grigore Cernaianu
Publication date: 01-02-2016
Publisher: Springer Japan
Published in: Surgery Today / Issue 2/2016
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI: https://doi.org/10.1007/s00595-015-1191-6

At a glance: The STEP trials

Springer Medicine

Transumbilical cord access (TUCA) for laparoscopy in infants and children: simple, safe and fast

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2016

Blunt aortic injury: risk factors and impact of surgical approaches

Surgical intervention strategy for postoperative chylothorax after lung resection

The safety and prognostic factors for mortality in extremely elderly patients undergoing an emergency operation

Liver transplantation for advanced hepatocellular carcinoma in patients with Child-Pugh A and B

Single-incision laparoscopic surgery for stricturing and penetrating Crohn’s disease

Clinical significance of breast cancer micrometastasis in the sentinel lymph node