Page 5 - WJOLS - Laparoscopic Journal

Laparoscopic Extracorporeal Clot Extrusion Under Local Anesthesia for Removal of Intraluminal Fibrin Clot

are counted like: the need for general anesthesia, the adverse 2. Twardowski ZJ, Pasley K. Reversed one-way obstruction of
physiologic effects of CO pneumoperitoneum, the the peritoneal catheter (the accordion clot). Perit Dial Int
2
requirement of operating room and experienced surgeon 1994;14:296-97.
and laparoscopic instruments, and the long duration of the 3. Hashimoto Y, Yano S, Nakanishi Y, Suzuki S, Tsutsumi M. A
method for opening an obstructed peritoneal catheter using an
procedure. 18 infusion accelator. Adv Perit Dial 1996;12:228-30.
The advantages of our laparoscopic technique are: no 4. Benevent D, Peyronnet P, Brignon P, et al. Urokinase infusion
need to general anesthesia, using N O instead CO that for obstructed catheters and peritonitis. Perit Dial Bull 1985;
2
2
eliminate adverse effect of CO retentions. Our procedure 5:77.
2
is simple and no need to full laparoscopic experiences or 5. Thompson N, Uldall R. A problem in peritoneal dialysis. Lancet
advanced instruments. Feasibility of this procedure under 1969;2:603-04.
local anesthesia and conscious sedation, provide it as an 6. Bergstein JM, Andreoli SP, West KW, Grosfeld JL.
appropriate method for all patients even for high-risk cases Streptokinase therapy for occluded Tenckhoff catheter in children
on CAPD. Perit Dial Int 1988;8:137-39.
for general anesthesia. 7. Hutchinson PJ, Chand DH. Use of tissue plasminogen activator
Using laparoscopy for removal of intraluminal fibrin clot in obstructed peritoneal dialysis catheters. Dial Transpl 2001;
is not new. 14-16 In some of the previous reports the 30:104-08.
clot was extracted intracorporealy by pushing the clot 8. McLaughlin K, Jardine AG. Closed stiff-wire manipulation of
intraluminally using gastroscopic biopsy forceps or urethral malpositioned Tenckhoff catheters offers a safe and effective
catheter, 14,16 or by milking the catheter using atraumatic way of prolonging peritoneal dialysis. Int J Artif Organs 2000;
23
laparoscopic forceps. In some other reports, extraction 23:219-20.
of PD catheter through laparoscopic port for rescuing the 9. Sharp J, Eastham EJ, Coulthard MG. Removal of a fibrin plug
malfunctioning catheter is suggested. At 1996, Crabtree from within a silastic peritoneal dialysis catheter: The sheastard
sweep. Perit Dial Int 1990;10:61-62.
reported one case of omental wrapping that after mobilization 10. Kumwenda MJ, Wright FK. The use of a channel-cleaning brush
of the catheter, it pulled out, permitting complete removal for malfunctioning Tenckhoff catheters. Nephrol Dial Transplant
of the omental and fibrin debris plugging the side holes and 1999;14:1254-57.
24
lumen of the catheter under direct vision. In review of the 11. Stringel G, Olsen S, Cascio C. Unblocking peritoneal dialysis
literature we could find also some other reports about this catheters with a combination of urokinase and Fogarty catheter
technique, 14,25 but all of them are under general anesthesia. manipulation. Advan Perit Dial 1995;11:200-01.
Extraction of the catheter from peritoneal cavity for a 12. Palmer R. Safety in laparoscopy. J Reprod Med 1974;13:1-5.
short period in a sterile filed could not be rise catheter 13. Keshvari A, Najafi I, Jafari-Javid M, Yunesian M, Chaman R,
contamination. Insisting to intracorporeal extrusion of the Nouri Taromlou MK . Laparoscopic peritoneal dialysis catheter
clot by intraluminal manipulation using different instruments implantation using a Tenckhoff trocar under local anesthesia
is most likely to raise contamination. Intracorporeal milking with nitrous oxide gas insufflations. Am J Surg 2009;197:8-13.
of the catheter by laparoscopic forceps is very time wasting 14. Zadrozny D, Lichodziejewska-Niemierko M, Draczkowski T,
and need to additional port site. Pulling out the catheter by Renke M, Liberek T. Laparoscopic approach for dysfunctional
open surgery for extraction of the clot or resolving other Tenckhoff catheters. Perit Dial Int 1999;19:170-82.
18
causes of malfunction that recently reported is not only 15. Ogunc G. Malfunctioning peritoneal dialysis catheter and
more invasive but can lead to new adhesion or restriction to accompanying surgical pathology repaired by laparoscopic
surgery. Perit Dial Int 2002;22:454-62.
continuing the peritoneal dialysis due to more peritoneal 16. Santarelli S, Zeiler M, Marinelli R, Monteburini T, Federico A,
trauma. Ceraudo E. Videolaparoscopy as rescue therapy and placement
The number of patients and catheters in this study is of peritoneal dialysis catheter: A thirty-two case single center
too small for meaningful statistical analysis. However, we experience. Nephrol Dial Transplant 2006;21:1348-54.
feel that the laparoscopic “ECCE” should be a considered 17. Yilmazlar T, Kirdak T, Bilgin S, Yavuz M, Yurtkuran M.
option for the management of catheter malfunction due to Laparoscopic findings of peritoneal dialysis catheter malfunction
fibrin clot. and management outcomes. Perit Dial Int 2006;26:374-79.
18. Sung-Ho K, Duk-Hyun L, Hee-Jeong C, Hye-Jin S, Ye-Soo J,
REFERENCES Dong-Hyun K, Jong-Hoon P, Chan-Duck K, Yong-lim K.
1. Crabtree JH, Burchette RJ. Effective use of long-term peritoneal Minilaparotomy with manual correction for malfunctioning
dialysis access. Am J Surg Jul 2009;198(1):135-41. peritoneal dialysis catheters. Perit Dial Int 2008;28:550-53.

World Journal of Laparoscopic Surgery, May-August 2010;3(2):55-58 57