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      Laparoscopic Peritoneal Dialysis Catheter Insertion Using a Quinton Percutaneous Insertion Kit

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          Abstract

          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 omen-topexy 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.

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          Most cited references27

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          Risk factors for conversion of laparoscopic cholecystectomy to open cholecystectomy.

          A Karayiannakis, A Polychronidis, C Simopoulos … (2005)
          Conversion to open cholecystectomy is still required in some patients. The aim of this study was to evaluate preoperative factors associated with conversion to open cholecystectomy in elective cholecystectomy and acute cholecystitis. The records of 1,804 patients who underwent cholecystectomy from May 1992 to January 2004 were reviewed retrospectively. The demographics and preoperative data of patients who required conversion to laparotomy were compared to those with successful laparoscopic cholecystectomy. Conversion to open cholecystectomy was needed in 94 patients (5.2%),of which 44 (2.8%) had no inflammation and 50 (18.4%) had acute inflammation of the gallbladder. Male gender, age older than 60 years, previous upper abdominal surgery, diabetes, and severity of inflammation were all significantly correlated with an increased conversion rate to laparotomy. Also, the conversion from laparoscopic to open cholecystectomy in acute cholecystitis patients was associated with greater white blood cell count, fever, elevated total bilirubin, aspartate transaminase, and alanine transaminase levels, and the various types of inflammation. None of these risk factors were contraindications to laparoscopic cholecystectomy. This may help predict the difficulty of the procedure and permit the surgeon to better inform patients about the risk of conversion from laparoscopic to open cholecystectomy.
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            A laparoscopic method for optimal peritoneal dialysis access.

            Arnold Fishman, Robert Crabtree (2005)
            Both medical benefits to the patient and financial incentives to the health care system exist to increase the use of peritoneal dialysis as renal replacement therapy. Providing long-term peritoneal access free of mechanical dysfunction continues to represent a major challenge to the success of this modality. Variable outcomes result from the lack of standard implantation methodology and failure to address persistent problems associated with current implantation techniques. This prospective case study compared noninfectious procedural complications of three approaches to establish peritoneal dialysis access. The groups consisted of 63 catheters implanted by traditional open dissection, 78 catheters implanted by basic laparoscopy without associated interventions, and 200 catheters implanted by advanced laparoscopic methods including rectus sheath tunneling, selective prophylactic omentopexy, and selective adhesiolysis. Mechanical flow obstruction, the major outcome indicator, followed only 1 of 200 (0.5%) implantation procedures in the advanced group and was significantly better (P < 0.0001) than the open dissection (17.5%) and basic laparoscopic (12.5%) groups. A low rate of pericannular leaks (1.3-2%) was not different for the three groups. One pericannular hernia occurred in the open group. Catheter mechanical dysfunction attributable to the surgical technique can nearly be eliminated through adjunctive procedures made possible only by a laparoscopic approach.
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              Laparoscopic omental fixation technique versus open surgical placement of peritoneal dialysis catheters.

              F Ersoy, D Oğünç, G Ogünç … (2003)
              Continuous ambulatory peritoneal dialysis (CAPD) is an effective form of treatment for patients with end-stage renal disease. Open insertion of peritoneal dialysis (PD) catheters is the standard surgical technique, but it is associated with a relatively high incidence of catheter outflow obstruction and dialysis leak. Omental wrapping is the most common cause of mechanical problems. The purpose of this study was to determine the efficacy of the laparoscopic omental fixation technique to prevent the obstruction caused by omental wrapping and also to compare this laparoscopic technique with open peritoneal dialysis catheter insertion with respect to postoperative discomfort, complication rates, and catheter survival. Between March 1998 and October 2001, 42 double-cuff, curled-end CAPD catheters were placed in 42 patients. The outcomes of the 21 patients in whom the PD catheters were placed laparoscopically with omental fixation technique were compared with those of the 21 patients in whom the catheters were placed with open surgical technique. Recorded data included patient demographics, catheter implantation method, early and late complications, catheter survival, and catheter outcome. Early peritonitis episodes occurred in 8 of 21 patients (38.0%) in the open surgical group (OSG) versus 2 of 21 patients (9.5%) in the laparoscopic omental fixation group (LOFG) ( p < 0.05); late peritonitis episodes occurred in 3 of 21 patients (14.2%) in the OSG versus 1 of 21 patients (4.7%) in the LOFG ( p < 0.05). Early exit site infection occurred in 8 of 21 patients (38.0%) in the OSG versus 4 of 21 patients (19.0%) in the LOFG ( p < 0.05), with many catheter-related problems in the conventional surgical group. There was no outflow obstruction in the LOFG. The conventional procedure was faster than the laparoscopic omental fixation technique. Analgesic requirements and hospital stay were less in the laparoscopic group. Laparoscopic surgery also enabled diagnosis of intraabdominal pathologies and treatment of the accompanying surgical problems during the same operation. Occult inguinal hernia was diagnosed in 2 patients, inguinal hernioplasty was performed in 4 patients, adhesiolysis was performed in 8 patients who had previous abdominal surgery, and liver biopsy was taken in 2 patients. Ovarian cystectomy was performed in another patient during laparoscopic CAPD catheter placement. The laparoscopic omental fixation technique (described by Oğünç and published in 1999) is a highly effective and successful method for preventing obstruction due to omental wrapping with a better catheter survival. Laparoscopic surgery also allows the diagnosis and treatment of the accompanying surgical pathologies during the same operation.
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                Author and article information

                Contributors
                Stephen P. Haggerty
                Tallal M. Zeni
                Mike Carder
                Constantine T. Frantzides
                Journal
                Journal ID (nlm-ta): JSLS
                Journal ID (iso-abbrev): JSLS
                Journal ID (hwp): jsls
                Journal ID (pmc): jsls
                Journal ID (publisher-id): JSLS
                Title: JSLS : Journal of the Society of Laparoendoscopic Surgeons
                Publisher: Society of Laparoendoscopic Surgeons (Miami, FL )
                ISSN (Print): 1086-8089
                ISSN (Electronic): 1938-3797
                Publication date (Print): Apr-Jun 2007
                Publication date PMC-release: Apr-Jun 2007
                Volume: 11
                Issue: 2
                Pages: 208-214
                Affiliations
                Department of Surgery, Evanston Northwestern Healthcare, Evanston, Illinois, USA.
                Department of Surgery, Evanston Northwestern Healthcare, Evanston, Illinois, USA.
                Evanston Northwestern Healthcare Highland Park Hospital, Highland Park, Illinois, USA.
                Department of Surgery, Evanston Northwestern Healthcare, Evanston, Illinois, USA.
                Author notes

                We would like to thank Rob Schuler for contributing the illustrations.

                Presented as a poster at the International Society for Peritoneal Dialysis, Chicago, Illinois, USA, April 29-May 1, 2005.

                Presented as an oral presentation at the Chicago Surgical Society Scientific Program, Chicago, Illinois, USA, February 2, 2006.

                Address reprint requests to: Stephen P. Haggerty, MD, 767 Park Avenue West, #320, Highland Park, IL 60035, USA. Telephone: 847 433 1060, Fax: 847 433 1399, E-mail: haggertys@ 123456ameritech.net
                Article
                PMC ID: 3015720
                PubMed ID: 17761082
                SO-VID: f21a72f7-8311-48fd-94fb-db393a6b8986
                Copyright © © 2007 by JSLS, Journal of the Society of Laparoendoscopic Surgeons.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License ( http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits for noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is not altered in any way.

                History
                Categories
                Subject: Scientific Papers

                ScienceOpen disciplines: Surgery
                Keywords: catheter,minimally invasive surgery,laparoscopy,catheter dysfunction,in-dwelling,continuous ambulatory peritoneal dialysis
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: catheter, minimally invasive surgery, laparoscopy, catheter dysfunction, in-dwelling, continuous ambulatory peritoneal dialysis

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