A simple device and technique for transumbilical open laparoscopy in children

In the last decade, transumbilical open laparoscopy has been widely used and accepted because it safely allows the insertion of the initial trocar without complication, such as major vascular or intra-abdominal visceral penetration. To avoid these complications, many authors have proposed using the open technique with a Hasson trocar. Pediatric-size laparoscopic equipment is difficult to obtain, however, so since 1992 the authors have used a simple device for open laparoscopy in pediatric patients. The open procedure is performed in the standard fashion. A small incision is made through the umbilical crease and is deepened through the linea alba. The peritoneum is picked up between hemostats and opened under direct vision. The distal part of a soft-seal endotracheal tube is forced over the end of the usual 5-mm cannula. The device thus assembled is inserted into the abdomen, and the balloon is inflated and is held back against the abdominal wall by the assistant. This maneuver avoids both gas leakage and sutures on the fascia and/or peritoneum. Since 1992 the authors have performed a total of 58 diagnostic and/or operative laparoscopies, using this simple device for open laparoscopy in 55 of them. No complications such as balloon burst or gas leakage have been recorded. This technique is safe, is time-saving, and does not require any sutures.