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Transumbilical cord access (TUCA) for laparoscopy in infants and children: simple, safe and fast
Ralf-Bodo Tröbs1, M Reza Vahdad2, Grigore Cernaianu3
1Department of Pediatric Surgery, Catholic Foundation Marienhospital Herne, Ruhr-University of Bochum, Widumer Str. 8, 44627, Herne, Germany. ralf-bodo.troebs@marienhospital-herne.de.
Insights
Transumbilical cord access (TUCA) is a safe and effective method for pediatric laparoscopic surgery. This technique demonstrates a low complication rate, making it suitable for various pediatric surgical procedures.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Surgical Access Techniques
Background:
- Transumbilical cord access (TUCA) offers a potential alternative for establishing abdominal entry in pediatric laparoscopic procedures.
- Evaluating the safety and complication profile of TUCA is crucial for its widespread adoption.
Purpose of the Study:
- To assess the safety and complication rate of transumbilical cord access (TUCA) in a large cohort of pediatric patients undergoing laparoscopic surgery.
- To determine the efficacy of TUCA across different pediatric surgical procedures.
Main Methods:
- A retrospective case series of 556 infants and children undergoing laparoscopic surgery using TUCA.
- Procedures included laparoscopic pyloromyotomy, herniorrhaphy, and appendectomy.
- Follow-up data were collected for a median of 24 months.
Main Results:
- No instances of severe bleeding or organ laceration were reported.
- Overall TUCA-related complications occurred in 1.6% of patients, including omphalitis and wound secretion.
- Minor complications such as umbilical pain and foreign body presence were managed, with no postoperative incisional hernias observed.
Conclusions:
- Transumbilical cord access (TUCA) is a safe and comfortable method for pediatric laparoscopic surgery.
- The technique is easily learned and can be rapidly and safely implemented in most pediatric patients.
- TUCA is a viable option for various pediatric laparoscopic procedures.
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.
