Laparoscopic placement of the Tenckhoff catheter for peritoneal dialysis

Continuous ambulatory peritoneal dialysis catheters can be inserted by open laparotomy as well as by laparoscopy. A prospective randomized study was scheduled to investigate the results of the laparoscopic versus open laparotomy technique for placement of continuous ambulatory peritoneal dialysis catheters. Fifty patients were enrolled and randomly allocated into two groups of 25 patients each. Group A underwent continuous ambulatory peritoneal dialysis catheter placement via the open laparotomy technique. In 22 patients, catheters were inserted via midline incision, and in 3 patients with histories of previous catheterization, a paramedian incision was used. Continuous ambulatory peritoneal dialysis was started 24 to 48 hours later. Group B underwent laparoscopic placement of the catheter with fixation into the pelvis and suture closure of the port wounds. In 21 patients, this catheter placement was the first such placement, and in 4 patients, a previous catheter had been inserted by the open technique and removed for dysfunction. Continuous ambulatory peritoneal dialysis was started at the end of the procedure. The mean operative time was 22 minutes in group A and 29 minutes in group B (P < 0.001). Fluid leakage was observed in eight patients in group A, but in no patients in group B (P < 0.005). Peritonitis occurred in five patients in group A and in three patients in group B (P > 0.1). Tip migration occurred in five patients in group A and no patients in group B (P < 0.005). In group B, two patients underwent a simultaneous cholecystectomy and one underwent incisional hernia repair. Laparoscopic placement of a Tenckhoff catheter leads to better function than does the open procedure; it allows immediate start of dialysis without fluid leakage and permits simultaneous performance of other laparoscopic procedures.     

COMPARATIVE EXPERIENCE OF A SIMPLE TECHNIQUE FOR LAPAROSCOPIC CHRONIC AMBULATORY PERITONEAL DIALYSIS CATHETER PLACEMENT

Background : Chronic ambulatory peritoneal dialysis (CAPD) is now an established technique for renal dialysis. Patients with renal failure cope poorly with major surgery and it is vital that the dialysis catheter tip is sited accurately in the pelvis if long-term catheter function is to be achieved. Laparoscopic placement of CAPD catheters may have potential advantages for renal patients by avoiding the morbidity of a laparotomy. Methods : A retrospective audit was performed of all CAPD catheters inserted at the John Hunter Hospital over a 2-year period. Results of laparoscopically inserted catheters and those placed at laparotomy were compared. Results : Sixty catheters were inserted, 30 laparoscopically and 30 at laparotomy. The mean operative time was 41 min in the laparoscopic patients and 57 min in the laparotomy patients (P= 0.0001). The mean total dose of narcotic administered postoperatively was significantly less in the laparoscopic group (5 mg vs 65 mg, P= 0.00002). There were three minor peri-operative complications in the laparoscopic group and seven peri-operative complications in the laparotomy group, three required reoperation and one resulted in the patient'death. There were no significant differences in the incidence of exit-site infection, catheter blockage, peritonitis, and overall catheter survival, although the laparoscopically placed catheters had been followed up for a shorter period (10 vs 16 months). Conclusions : This laparoscopic technique is safe and effective. Postoperative pain was less than for open placement. Laparoscopically placed catheters had a low incidence of peri-operative complications. Medium-term patency is similar to conventionally placed catheters. This procedure requires no additional equipment to that available for laparoscopic cholecystectomy and takes less time than the open operation.     

Needleoscopic placement of Tenckhoff catheters.

BACKGROUND: Minimally invasive techniques are being developed for the placement of peritoneal dialysis catheters. A needleoscopic technique that utilizes only two punctures is described. METHODS: Twelve patients underwent 13 needleoscopic Tenckhoff catheter placement procedures between November 1995 and May 1998. An additional six patients underwent the same procedure using a standard 10 mm laparoscope. The patients were followed prospectively for type of anesthesia and operative time for the procedure, whether the procedure was performed as an inpatient or an outpatient, and for any complications or leakage following the procedure. RESULTS: The needleoscopic procedure was able to be performed with an average operative time of 12 minutes. Twenty-three percent (23%) were performed under local anesthesia and thiry-eight (38%) were treated as outpatients. CONCLUSION: Needleoscopic Tenckhoff catheter placement is very simple to perform and can be performed under local anesthesia with minimal discomfort, secure catheter placement, and no leakage.     

Laparoscopic management of peritoneal dialysis catheters

Continuous ambulatory peritoneal dialysis catheter could be placed also by open laparotomy as well as by laparoscopic techniques. We did a retrospective study on cases to compare the results of laparoscopies. There were included 42 patients which we divided in two groups of 21. Group A underwent 21 cases in which catheters was inserted by open laparotomy. Continuous ambulatory peritoneal dialysis was started in 24 to 48 hours later. Group B incharged 21 patients underwent laparoscopic placement of the catheter between 2000 and 2001. Continuous peritoneal dialysis was started early (after 6 hours). The mean operative time was 28 minutes in group A and 30 minutes in group B. Fluid leakage was noticed in 4 patients in group A and in 3 patients in group B. Peritoneal reactions occurred in 5 patients in group A and in 2 patients in group B. Tip migration occurred in 5 patients in group A (one of which was mobilized accidentaly early after intervention) in which was necessary 4 open reinterventions, and no patients in group B. In group B one patient underwent a simultaneous liver biopsy for cirosis and another female patient underwent ovariectomy for a giant ovary cyst. Laparoscopic placement of dialysis catheter leads to better function than does open procedure, it allows immediate start of dialysis and permits simultaneous performance of other laparoscopic procedures.     

Mini‐laparoscopic placement of peritoneal dialysis catheter: New technique

Background: Leakage remains a problem with all methods of catheter placement. We describe our experience with a new mini‐laparoscopic technique for catheter placement in patients with end‐stage renal failure. Patients and methods: Between May 2002 and March 2004, 24 patients underwent mini‐laparoscopic placement of peritoneal dialysis catheters. All patients had end‐stage renal failure with difficult vascular access for haemodialysis. There were 11 men and 13 women with a mean age of 51.4 years (range: 18–75 years). Operative time, interval to initiation of successful peritoneal dialysis, postoperative pain management, resumption of diet and postoperative complications were recorded. Results: The mean operative time was 32.3 min (range: 15–40 min). All patients were given a normal diet on the day of surgery. Postoperative pain was controlled with paracetamol tablets three times daily for 2–3 days. The mean hospital stay was 3.2 days (range: 3–4 days). No patients developed leakage either from the ports or around the catheter. Two (8.3%) patients had blockage of the catheter and underwent diagnostic laparoscopy and laparoscopic correction. Two (8.3%) patients had migration of the catheter which required laparoscopic repositioning. The follow‐up range was between 2 and 22 months. Conclusion: Mini‐laparoscopic technique for placement of peritoneal dialysis catheter is unique because it uses only two ports. The catheter is made to exit via a 2 mm port site and does not require specially designed instruments.     

Laparoscopic-assisted placement of peritoneal dialysis catheters: implantation technique and results

BACKGROUND: Peritoneal dialysis is a generally accepted method for the treatment of patients with end-stage renal failure. The laparoscopic placement of peritoneal dialysis catheters is a well-established technique and offers some advantages, such as a safer placement of the catheter, less post-operative complications, and a longer functional survival, compared to the conventional open technique. The aim of this study was to describe our implantation technique and to determine the results of our approach. PATIENTS AND METHODS: Between January 2000 and February 2006, 47 patients with end-stage chronic renal failure underwent a laparoscopic peritoneal dialysis catheter insertion procedure. Perioperative and follow-up data were collected prospectively. RESULTS: The mean operating time was 35 minutes (range, 16-100). There was no perioperative morbidity. Nine (19.1%) patients experienced 10 mechanical complications: fluid leakage in 6 (12.8%) patients, acute hydrothorax in 1 (2.1%), catheter tip migration in 2 (4.3%), and catheter obstruction in 1 (2.1%) patient. Episodes of peritonitis were observed in 5 (10.6%) patients. One (2.1%) patient developed a catheter infection. In 3 (6.4%) patients, a port site hernia occurred that required surgical repair, 5 (10.6%) patients underwent laparoscopic revisions owing to mechanical complications, 9 (19.1%) patients underwent renal transplantation, and 6 (12.8%) patients died during the later follow-up. After a mean follow-up time of 17 months (range, 2-76), 30 (63.8%) catheters are still in use for dialysis. CONCLUSIONS: The functional outcome of the dialysis catheters was satisfactory in the majority of patients in this study. The described technique for catheter implantation is simple and safe, and in our opinion, the laparoscopic technique should be considered as the method of choice in patients with end-stage chronic renal failure.     

Indwelling interscalene catheter use in an outpatient setting for shoulder surgery: technique, efficacy, and complications

Indwelling interscalene catheters are utilized for inpatient postoperative pain control after shoulder surgery. Improved medical equipment and advanced techniques may allow safe and efficacious outpatient use. One hundred and forty-four consecutive indwelling interscalene catheter placements were reviewed to determine adverse events, complications, and efficacy. Real-time ultrasound-guided catheter placement technique is described. Post-anesthesia care unit (PACU) narcotic consumption and last recorded pain score were reviewed to gauge efficacy. The catheter placement technique was 98% successful. There were 14 (9.7%) minor adverse events including inadequate analgesia (8), accidental catheter removal (4) of disconnection (1), and shortness of breath (1). The single complication (0.7%) was a small apical pneumothorax. The average PACU narcotic consumption in intravenous morphine equivalents was 1.7 mg. The average last recorded PACU pain score on a scale of 1 to 10 was 0.6. Catheter placement under real-time ultrasound guidance is accurate. Outpatient use of indwelling interscalene catheters is safe and efficacious.     

A novel minimally invasive technique for insertion of peritoneal dialysis catheter

The placement of a continuous ambulatory peritoneal dialysis (CAPD) catheter by conventional open surgical or trocar technique may cause a number of complications such as infection, hemorrhage, leakage, incisional hernia, and visceral organ perforation. Most complications are related to open surgery or insertion of the catheter with the guidewire without direct visualization. Insertion of the catheter laparoscopically under direct visualization has been previously described. The authors who described this technique used two or three ports for the camera and instruments. In this study we describe a laparoscopic technique for insertion of the peritoneal dialysis catheter under direct visualization with use of one-camera port and an accessory 2-mm umbilical incision. This prospective study was performed with the approval of the ethics committee of the Gazi University Hospital, in Ankara, Turkey. There were a total of eight patients: five males and three females, with an average age of 34.3 years (range, 11-54), who underwent laparoscopic CAPD insertion between 1997 and 2000. The catheter was inserted into the abdominal cavity 2 cm below the umbilicus. The subcutaneous tunnel was made with the assistance of a specially designed L-shaped trocar. All patients did well after the operation and had excellent cosmetic results. There was one leak in the early postoperative period, which was treated conservatively. The average operating time was 34.7 minutes (range, 25-45 minutes). The laparoscopic approach for peritoneal dialysis catheter insertion, for management of transmigrated CAPD catheters, and to resolve omental occlusions should be considered as an alternative to open surgery, especially for patients who have peritoneal adhesions secondary to a history of abdominal surgeries or recurrent peritonitis.     

Laparoscopic placement and revision of peritoneal dialysis catheters.

Chronic peritoneal dialysis is an option for many patients with end stage renal disease. Laparoscopy offers an alternative approach in the management of dialysis patients. Over an 18-month period, laparoscopy was used for placement or revision of seven peritoneal dialysis catheters. All were placed in patients with end stage renal disease for chronic dialysis. Two catheters were initially placed using the laparoscope, and in five other patients, the position of the catheter was revised. Of the two patients who had their catheters placed initially, one patient had a previous lower mid-line incision and underwent laparoscopic placement of a catheter and lysis of pelvic adhesions. The second patient had hepatitis C and chronically elevated liver function tests. He underwent laparoscopic placement of a peritoneal dialysis catheter and liver biopsy. Five patients had laparoscopic revision for non-functional catheters. Four were found to have omental adhesions surrounding the catheter. Three patients were found to have a fibrin clot within the catheter, and in one patient the small bowel was adhered to the catheter. All seven patients had general endotracheal anesthesia. There were no operative or anesthetic complications. The average operative time was 56 minutes. Four patients had their procedure in an ambulatory setting and were discharged home the same day. One patient was admitted for 23-hour observation, and two patients had their procedure while in the hospital for other reasons. In follow-up, there was one early failure at two weeks, which required removal of the catheter for infection. One catheter was removed at the time of a combined kidney/pancreas transplant eight months after revision. The other five catheters are still functional with an average follow-up of ten months. These results suggest that laparoscopy is another method for placement of peritoneal dialysis catheters and more importantly for revision in patients with nonfunctional catheters secondary to adhesions. It also provides an opportunity to evaluate the abdomen and perform concomitant procedures.     

Secure placement of continuous ambulatory peritoneal dialysis catheters under laparoscopic assistance

Laparoscopic surgical procedures were performed in 18 patients with end-stage renal disease for the placement of a Tenckhoff peritoneal dialysis catheter. Among them, 6 patients had received previous lower abdominal surgical treatment and 3 patients underwent laparoscopic rescue of dysfunctional Tenckhoff catheters. The operating time was between 40 and 80 minutes (median, 50 minutes). After a median follow-up period of 11 months, the short-term results revealed that no significant morbidity was associated with this procedure, and all catheters except two functioned well postoperatively. One of the catheters was not functional because of the patient's death, and the other one was removed because of persistent peritonitis. Laparoscopic secure placement of continuous ambulatory peritoneal dialysis catheters appears to be a simple, safe, and viable procedure, even in patients with previous lower-abdominal operations. The same technique can be used to rescue dysfunctional catheters that are displaced or obstructed by adhesion and omental wrapping, thus increasing catheter longevity.     

Primary laparoscopic placement of peritoneal dialysis catheters in children and young adults

Background: Primary placement of peritoneal dialysis catheters in children often requires suturing of the catheter into the pelvis. We describe our experience with a gasless laparoscopy technique in children and young adults. Methods: During an 18-month period, 12 patients (mean age, 14 years) underwent primary laparoscopic placement of peritoneal dialysis catheters. A single umbilical port was used for abdominal wall elevation, telescope, and catheter. A needleholder was introduced via an accessory port at the future catheter exit site or through the umbilical port. Omentectomy was performed through the umbilical incision. The catheter was tunneled to the lateral abdominal wall. Follow-up data (≥15 months) included time to initiation of dialysis, hospitalization, and outcome. End points were cure, transplantation, or death. Results: Diet was started on the day of surgery and dialysis on the following day. Four patients had seven complications, including leakage and entanglement of the catheter in tubal fimbriae. Long-term revision-free catheter survival was 67% at 24 months. Conclusions: This minimal access technique for primary placement of peritoneal dialysis catheters includes securing of the catheter tip in a dependent location and omentectomy. It allows nearly immediate use of the catheter, leads to a minimal hospital stay, and has acceptable long-term patency. Received: 24 December 1998/Accepted: 3 March 1999     

William Stewart Halsted: Father of American Modern Surgery

Peritoneal dialysis is an established alternative method for the management of patients with end-stage renal disease. Recently, laparoscopy has been utilized in assisting the insertion of catheters under direct vision. The efficacy of the laparoscopic approach for patients with a history of abdominal surgery remains largely unknown. The purpose of this study is to evaluate laparoscopy in the placement of peritoneal dialysis catheters for selected patients with previous abdominal operation. Laparoscopic assisted placement of peritoneal dialysis catheters was performed in 20 patients, who were carefully selected preoperatively and who also underwent previous abdominal operation between April 1999 and July 2001. Previous abdominal operation included appendectomy, ovarian resection, hysterectomy, cesarean section, open cholecystectomy, segmental resection of the small intestine, and truncal vagotomy with pyloroplasty. The procedure was performed using two 10-mm and one 5-mm abdominal trocar. All of the patients tolerated this procedure without significant surgical complications. However, 3 patients developed temporary hemoperitoneum, and 1 patient developed dialysate leakage. The overall success rate of catheter function (> 30 days after laparoscopy) was 90%, except in 2 cases where the catheter functioned poorly due to severe intra-abdominal adhesions. Simultaneous laparoscopic adhesiolysis was successfully performed in 5 cases. Laparoscopic implantation of peritoneal dialysis catheters appears to be a straightforward procedure, even for patients with previous abdominal operation. We believe that this technique may extend the application of peritoneal dialysis treatment in patients with previous abdominal surgery after discreet evaluation preoperatively.     

Laparoscopic assisted placement of peritoneal dialysis catheters for selected patients with previous abdominal operation.

Peritoneal dialysis is an established alternative method for the management of patients with end-stage renal disease. Recently, laparoscopy has been utilized in assisting the insertion of catheters under direct vision. The efficacy of the laparoscopic approach for patients with a history of abdominal surgery remains largely unknown. The purpose of this study is to evaluate laparoscopy in the placement of peritoneal dialysis catheters for selected patients with previous abdominal operation. Laparoscopic assisted placement of peritoneal dialysis catheters was performed in 20 patients, who were carefully selected preoperatively and who also underwent previous abdominal operation between April 1999 and July 2001. Previous abdominal operation included appendectomy, ovarian resection, hysterectomy, cesarean section, open cholecystectomy, segmental resection of the small intestine, and truncal vagotomy with pyloroplasty. The procedure was performed using two 10-mm and one 5-mm abdominal trocar. All of the patients tolerated this procedure without significant surgical complications. However, 3 patients developed temporary hemoperitoneum, and 1 patient developed dialysate leakage. The overall success rate of catheter function (> 30 days after laparoscopy) was 90%, except in 2 cases where the catheter functioned poorly due to severe intra-abdominal adhesions. Simultaneous laparoscopic adhesiolysis was successfully performed in 5 cases. Laparoscopic implantation of peritoneal dialysis catheters appears to be a straightforward procedure, even for patients with previous abdominal operation. We believe that this technique may extend the application of peritoneal dialysis treatment in patients with previous abdominal surgery after discreet evaluation preoperatively.     

Outcomes of tunneled femoral hemodialysis catheters: comparison with internal jugular vein catheters

BACKGROUND: Tunneled femoral vein dialysis catheters are used as a last resort when all other options for a permanent vascular access or thoracic central vein catheter have been exhausted. There is little published literature on the complications or outcomes of tunneled femoral catheters. METHODS: Using a prospective, computerized vascular access database, we identified all tunneled femoral dialysis catheters placed at the University of Alabama at Birmingham during a five-year period. The clinical features, catheter patency, and complications in these patients were compared to those observed in a group of sex-, age-, and date-matched control patients with tunneled internal jugular vein dialysis catheters. RESULTS: During the study period, 27 patients received a tunneled femoral dialysis catheter, accounting for 1.9% of all tunneled catheters placed. Only 7 patients (26%) were able to convert to a new permanent dialysis access. The primary catheter patency (time from placement to exchange) was substantially shorter for femoral catheters than for internal jugular dialysis catheters (median survival, 59 vs. >300 days, P < 0.0001). Infection-free survival was similar for both groups (P= 0.66). Seven patients with femoral catheters (or 26%) developed an ipsilateral deep vein thrombosis, but catheter use was possible with anticoagulation. CONCLUSION: Tunneled femoral dialysis catheters have a substantially shorter primary patency, but a similar risk of catheter-related bacteremia, as compared with internal jugular vein catheters. An ipsilateral lower extremity deep vein thrombosis occurs commonly after placement of a femoral dialysis catheter, but does not preclude continued catheter use.     

Comparison of open and laparoscopic secure placement of peritoneal dialysis catheters

Background A major and frustrating complication of peritoneal dialysis catheter placement is mechanical outflow obstruction, which may be caused by catheter tip migration. Therefore, a secure and correct positioning of the catheter is important to minimize this risk. This technique is easily accomplished by a laparoscopic approach.Methods The outcomes of 50 patients in whom peritoneal dialysis catheters were inserted laparoscopically with a secure catheter placement technique were compared with those of 52 patients who underwent an open surgical technique using a stiff wire as guidance for the catheter. The data were prospectively collected but not randomized. All the patients had virgin abdomens, and all the procedures were undertaken or supervised by one surgeon.Results Catheter migration occurred in six patients (12%) in the open group, as compared with none in the laparoscopic group (p = 0.027). There were no significant differences in catheter survival between the two groups.Conclusions The laparoscopic technique with secure placement of the catheter lowered the incidence of catheter migration, but did not increase the catheter survival.     

Laparoscopic implantation of swan neck presternal peritoneal dialysis catheters

The swan neck presternal peritoneal dialysis catheter provides an alternative location from which a catheter can exit the skin when an abdominal site is not suitable. The exit site is in the upper anterior chest. The presternal catheter was designed for patients who would not ordinarily be considered for peritoneal dialysis because of body habitus, presence of stomas, or urinary-fecal incontinence. In its original design, the catheter can be implanted only by open dissection. We present a modification of the catheter system and describe an operative technique in which the catheter can be inserted laparoscopically. Eight patients underwent laparoscopic implantation of presternal catheters by this technique. During follow-up ranging from 2.9 to 12.4 months (average, 5.3 months), no instances of catheter dysfunction, leakage around the cannula, hernia, or loss secondary to infection occurred. We foresee greater use of the swan neck presternal peritoneal dialysis catheter once surgeons become more familiar with its ease of insertion and if the device can be made available as a single-package system compatible with laparoscopic implantation.     

Peritoneal dialysis catheter placement—is laparoscopy an option?

Abstract Peritoneal dialysis (CAPD) is the preferred and gentlest type of dialysis in patients with end-stage renal disease (ESRD). One of the most frequent complications following peritoneal dialysis catheter (P-catheter) placement is malfunction owing to displacement, which frequently entails major problems for the patient, including reoperation and the risk of having to switch to haemodialysis. Consequently, to ensure optimal P-catheter function and reduce patient morbidity, it is essential to develop and assess new surgical techniques for dialysis catheter placement. The objective of this survey is to describe and assess a laparoscopic-assisted procedure for P-catheter placement. Material and methods Survey of laparoscopic-assisted P-catheter placements performed during a one-year period. The study describes the operative procedure, catheter function and complications. Furthermore, a comparison with open surgery performed in the period is made. Results One of nine P-catheters inserted using laparoscopic-assisted surgery under general anaesthesia was displaced while four of 13 P-catheters inserted using traditional open surgery under local anaesthesia were displaced. The five displaced catheters were subsequently fixed laparoscopically under general anaesthesia. Conclusion Laparoscopic P-catheter placement is uncomplicated, quick and reduces P-catheter displacement frequency. Drawbacks include costly equipment and the need for general anaesthesia. Future follow-up will reveal whether laparoscopically placed P-catheters yield longer-lasting and better-functioning catheters than traditionally placed P-catheters.     

Use of electrocardiogram to position right atrial catheters during surgery.

OBJECTIVE: This study evaluated the accuracy of placing right atrial catheters using an electrocardiographic (ECG) technique. SUMMARY BACKGROUND DATA: Placement of right atrial catheters for vascular access is a common operative procedure. Accurate placement is essential for proper function. Previous placement techniques have used fluoroscopy, which is both time consuming and hazardous. METHODS: The accuracy of placement of 1236 right atrial catheters using an ECG technique was compared to placement of 586 catheters using fluoroscopy between March 1991 and November 1995. In the ECG technique, the catheter was flushed with sodium bicarbonate. A sterile left-leg ECG lead was attached to the catheter with the other ECG leads applied normally. On advancing the catheter through the superior vena cava, the P-wave amplitude (lead II) increased in negative deflection until greater than the QRS complex. Passing the sinoatrial node, the P-wave developed an initial positive then negative deflection. The catheter was positioned so the P-wave was biphasic, representing a position midway between the sinoatrial and atrioventricular nodes. For the fluoroscopic technique, catheters were positioned under direct observation just within the atrium estimated from cardiac contour. Use of contrast was optional if atrial anatomy was unclear. RESULTS: Postoperative portable chest x-rays showed the ECG method to position the catheter tip within the right atrium just as accurately (average, 1.9 +/- 1.3 cm) as with the use of fluoroscopy (average, 1.1 +/- 1.6 cm). The ECG method eliminated an average of 20 seconds of radiation exposure, an average of 3.0 minutes operating room time (p < 0.04), avoided all risks of contrast dye, and saved $279.10 per case. CONCLUSIONS: The ECG method is a satisfactory alternative to that of fluoroscopy for placement of long-term central venous catheters into the right atrium.     

Robotic catheter ventriculostomy: feasibility, efficacy, and implications

OBJECT: Robotic applications hold great promise for improving clinical outcomes and reducing complications of surgery. To date, however, there have been few widespread applications of robotic technology in neurosurgery. The authors hypothesized that image-guided robotic placement of a ventriculostomy catheter is safe, highly accurate, and highly reproducible. METHODS: Sixteen patients requiring catheter ventriculostomy for ventriculoperitoneal (VP) shunt or reservoir placement were included in this retrospective study. All patients underwent image-guided robotic placement of a ventricular catheter, using a preoperatively defined trajectory. RESULTS: All catheters were placed successfully in a single pass. There were no catheter-related hemorrhages and no injuries to adjacent neural structures. The mean distance of the catheter tip from the target was 1.5 mm. The mean operative times were 112 minutes for VP shunt placement and 42.3 minutes for reservoir placement. The mean operative times decreased over the course of the study by 49% for VP shunts and by 19% for reservoir placement. CONCLUSIONS: The robotic placement of a ventriculostomy catheter using a preplanned trajectory is safe, highly accurate, and highly reliable. This makes single-pass ventriculostomy possible in all patients, even in those with very small ventricles, and may permit catheter-based therapies in patients who would otherwise be deemed poor surgical candidates because of ventricle size. Robotic placement also permits careful preoperative study and optimization of the catheter trajectory, which may help minimize the risks to bridging veins and sulcal vessels.     

Laparoscopic peritoneal dialysis catheter insertion using a Quinton percutaneous insertion kit.

OBJECTIVE: We assessed a unique technique of laparoscopic peritoneal dialysis (PD) catheter insertion which can minimize catheter dysfunction. METHODS: We performed a retrospective review of patients undergoing laparoscopic PD catheter placement with a Quinton percutaneous insertion kit between July 2000 and December 2004. RESULTS: Thirty-one catheters were placed laparoscopically. The mean operating time was 52 minutes. Adhesiolysis was required in 9 (29%) and omentectomy or omentopexy in 3 (10%) cases. Late complications included catheter dysfunction in 2 patients (6.5%), debilitating abdominal pain requiring catheter removal in 1 patient, and 1 trocar-site hernia. The mean follow-up was 17 months. CONCLUSIONS: Laparoscopic PD catheter insertion using a Quinton percutaneous insertion kit is safe, reproducible, and effective. It facilitates placement of the catheter tip into the pelvis and allows adhesiolysis, omentectomy, or omentopexy when necessary. Utilization of this technique results in a low rate of PD catheter dysfunction.