756
CUELLAR ET AL.
cation.
of these
had
a
lower umbilical incision
dure, it is convenient to create the
umbilical
described.8 In our
for
la¬
Forty
patients
posterior
flap
for the introduction of the
trocar, while 12 of them had
had 5-mm dilators, and 15
had 10-mm dilators (all for later umbilical stoma creation). In
later stoma formation as
previously
Step
Thirty-six
early
umbilical incisions.
Veress needle access9 was used rou¬
paroscopic experience,
were no
upper
for
of all
the loose
ages. Although there
tinely
cant
patients
results in
signifi¬a
insufflation in children. Al¬
one case,
obturators.
Of the 52
did not interfere with the
toneal
space
cessful in both
a
5-mm trocar was
to 10 mm by exchanging
upsized
complications,
peritoneal envelope
higher incidence of
though open access
preperitoneal
there was one with
that
has been obtained
various
procedures,
gas leakage
In two cases, the
using
techniques,
the standard at our institution is now the use of the radially di¬
procedure.
accessed;
a
second
These were both inferior umbilical
preperi¬
suc¬
was
attempt was
lating trocar.
initially
patients.
incisions. There were no
or
com¬
intraoperative
laparoscopic
postoperative
access or the umbilical
associated with
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of Urology
Children's Hospital of Pittsburgh
3705
Avenue
laparoscopic
at the authors'
of Pittsburgh
Department
In the
of
surgeon.
institution, indications for open access include young age and
small size, of the lower abdom¬
or other
practice
pediatric laparoscopy
kyphosis
abnormality
of abdominal
stoma in the umbilicus. At the
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inal anatomy,
place a
and the need to
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Pittsburgh, PA 15213
history
surgery,
of the
beginning
proce¬
Audibert
