How I do itA new simplified one port laparoscopic technique of peritoneal dialysis catheter placement with intra-abdominal fixation
Section snippets
Methods
Through a supra-umbilical 1-cm incision, a 10-mm port is placed using the open laparoscopic technique [20]. This port serves for the pneumoperitoneum installation and the introduction of the optics. The Peritoneal Catheter kit (Quinton Instrument Company, Seattle, WA) for modified Seldinger (Littleford-Spector) technique and a 16 French Pull-Apart Sheath Introducer (Sherwood Medical Company, St. Louis, MO) are used for the catheter placement. The length of the catheter to be inserted has been
Results
From March 2004 to February 2005 we used this technique on 13 consecutive patients with end-stage renal failure. The contraindications for the technique were those regarding general anesthesia and pneumoperitoneum. Three patients had previous operations of the lower abdomen. One of these patients necessitated the use of an additional port for adhesiolysis. No case was converted to open surgery. The patients were evaluated monthly for a mean follow-up period of 5 months.
One surgeon (H.H) with an
Comments
Since the lack of controlled studies makes it impossible to answer in a definitive way which technique for peritoneal dialysis catheter placement is best, we prefer to approach the problem as a 2-fold question: what is the safest access in the peritoneal cavity for the catheter placement and which technical factors influence the longevity of a peritoneal catheter?
For the first problem, a wise solution would be a method whose access combines the pros of every method—local anesthesia (as with
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