Page 3 - WALS Journal

10.5005/jp-journals-10033-1169
Najeeb H Mir
REVIEW ARTICLE
Two Port Laparoscopic Placement of Peritoneal Dialysis

Catheter: Effective Technique

Najeeb H Mir

ABSTRACT Peritoneal dialysis is a good alternative for ESRD
patients who are on hemodialysis. It involves infusing
Aim: Two port laparoscopic placement of peritoneal dialysis
(PD) catheter is a new and promising technique which is reliable, dialysis fluid into the peritoneal cavity through PD catheter
efficient and with less complications. and leaving it inside the abdomen to allow exchange of

Materials and methods: Data collection was done using the metabolic waste products between the body fluid and the
internet via Google search engine, Medscape, PubMed, dialysis fluid through the peritoneal membrane.
SAGES, Springer, NCBI, Nefrolgia and International journal of In continuous ambulatory peritoneal dialysis (CAPD), the
peritoneal dialysis. At least five study groups were analyzed
who used two ports laparoscopy for PD catheter placement from patient manually drains and replaces the dialysis fluid
2004 to 2010. several times a day.
Results: Mean operating time was between 32 and 52 minutes. A PD catheter is conventionally placed through a small
No other technical intra or early postoperative complications open incision, which may be carried out under local or
related to technique were reported. Surgical revision was general anesthesia. PD catheters according to Tenckhoff
required in 6%, catheter survival was 94, 87 and 72% after are traditionally implanted by a transrectus laparotomy.
6 months, 1 and 2 years survival, catheter leakage was
between 0 and 22.2%, catheter outflow failure was between A small incision is made in the abdomen and peritoneal
0 and 7.6%, catheter migration was between 2.6 and 4%, no cavity is entered and the catheter is placed into the pelvic
life-threatening bleeding was noted, peritonitis was between cavity. A tight purse-string suture is passed through the
6.5 and 13% and exit site infection was seen in 3% of
the patients. Mean follow-up was between 17 months and peritoneum and rectus sheath around the catheter. The other
2 years. end of the catheter is taken out on to the abdomen after
making a subcutaneous tunnel.
Conclusion: Two port laparoscopic PD catheter insertion is a
safe, reproducible, and effective technique. It allows inspection PD catheter can be placed via percutaneous techniques
of the abdominal cavity and adhesiolysis, omentectomy, or as well.
omentopexy when necessary. Due to its reliability, offers good
catheter function outcome. MATERIALS AND METHODS

Keywords: Laparoscopy, Peritoneal dialysis, Catheter, Surgical
revision, Catheter migration. Data collection was done using the internet via Google
search engine, Medscape, PubMed, SAGES, Springer,
How to cite this article: Mir NH. Two Port Laparoscopic NCBI, Nefrolgia and International journal of peritoneal
Placement of Peritoneal Dialysis Catheter: Effective Technique.
World J Lap Surg 2012;5(3):146-149. dialysis.
Laparoscopic PD catheter insertion is usually performed
Source of support: Nil
under general anesthesia. After the insufflation of abdomen
Conflict of interest: None small incisions are made. The catheter-tip is advanced
through the abdominal cavity into the pelvic cavity. After
INTRODUCTION making a subcutaneous tunnel, the other end of the catheter
In 1959, peritoneal dialysis (PD) was used for the is taken out via an exit site incision in the abdomen.
1
management of end-stage renal disease (ESRD). Henry Laparoscopy allows complete visualization of the catheter’s
Tenckhoff developed the first indwelling peritoneal catheter configuration, location, and facilitates more accurate
in 1968, which was used for dialysis by an open surgical placement of PD catheter within the pelvis.
technique. 2
Laparoscopic insertion (keyhole surgery)–is a way of TECHNIQUE
inserting the catheter using a fine telescope to guide the Patient is kept in supine position and a 1 to 1.5 cm supra-
catheter into the abdominal cavity. Laparoscopy is umbilical incision is made and pneumoperitoneum created
minimally-invasive, and also allows inspection of the using a Veress needle and insufflation of carbon dioxide is
peritoneal cavity with the feasibility of correcting any put at pressure of 12 to 14 mm Hg. A 10 mm port is then
pathology inside the abdomen. Hence, diagnostic accuracy inserted, a laparoscopic camera is introduced and
is improved. exploration carried out. A 5 mm port is then inserted through
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