Transumbilical Access for Pneumoperitoneum (Modified Hasson Procedure) in Laparoscopy in Children and Adolescents

Abstract

Two principal methods are used to introduce the pneumoperitoneum in laparoscopic procedures. The first and most common technique is blind insertion of the Veress needle, followed by blind puncture of the abdominal wall with a sharp trocar. The second is the open method first described in 1971 by Hasson. Either method produces a scar at least 3 to 4 cm long in the umbilical region. We present a study of 191 consecutive cases (age range, 1.6–29 years; median, 12 years) in which a longitudinal transumbilical access through the lower umbilicus was achieved for insertion of a blunt trocar. The technique is compared with the periumbilical transverse incision and the gridiron incision. Our technique renders a much better cosmetic result and better stability, while maintaining the safety of the Hasson method.