Laparoscopic assisted placement of peritoneal dialysis catheter: a preliminary experience.

MATERIALS AND METHODS: Peritoneal dialysis catheters have been successfully placed via an open surgical technique, the percutaneous method, and the peritoneoscopic-assisted percutaneous methods. The latter two techniques produced lower complication rates, quicker use of the catheter, and longer functional survival, but also carried the risk of vascular and visceral injury during blind entry with a Varess needle or other penetrating instrumentation. A new technique is described which reduces the incidence of this iatrogenic complication and provides greater visualization of the peritoneal cavity. Using open laparoscopy as described by Hasson, a Tenckhoff catheter is placed in the peritoneal cavity and an adequate pneumoperitoneum is created. An operative laparoscope facilitates ideal visualization and distal catheter placement. A small separate incision is created for catheter exit.
RESULTS: Ten patients underwent placement or repositioning of the catheter with this new method. One patient experienced outflow obstruction subsequent to open surgical placement, necessitating repositioning.
CONCLUSION: The laparoscopic-assisted placement allows for thorough inspection of the peritoneal cavity and greater distal catheter inspection and placement, as well as reducing the risk of iatrogenic intra-abdominal visceral or vascular injury.