A NEW TECHNIQUE APPLICABLE TO PEDIATRIC LAPAROSCOPIC SURGERY - ABDOMINAL-WALL AREA LIFTING WITH SUBCUTANEOUS WIRING

Background: Recently, the authors developed a unique method of laparos copic surgery without pneumoperitoneum: ''area lifting of the abdomina l wall with subcutaneous wiring.'' Methods: In this gasless procedure, the anterior abdominal wall is pulled upward by a pair of wires place d subcutaneously and held by thick sutures for ''hanger lifting.'' Sim ultaneous lifting of a pair of subcutaneous wires across the abdomen, produces a wide, roof-shaped intraabdominal space sufficient for lapar oscopic surgical procedures. The practical aspects of this gasless tec hnique, as well as the authors' limited experience with this method in 24 children, ranging from 8 days to 15 years of age is presented. The se children have had various pathologies including splenomegaly, recta l prolapse, ovarian cyst, gall stone, adrenal neuroblastoma, and abdom inal wall abscess. Conclusions: Gasless laparoscopic surgery with doub le subcutaneous wiring is safe for children including neonates and tho se with respiratory compromise because all operative procedures are pe rformed under normal abdominal pressure. Because of the highly elastic abdominal wall musculature inherent in children, this selective area lifting of abdominal wall creates a relatively larger peritoneal Volum e than in adults. Copyright (C) 1998 by W.B. Saunders Company.