Introducer-free MIS-assisted Ventriculoperitoneal Shunt Placement: A Technical Document

Abstract

Background The placement of the distal catheter of a ventriculoperitoneal shunt (VPS) can be challenging in patients with a large body habitus. Given the complications associated with ventriculoperitoneal shunts and known infection risk of obese patients, new techniques for VPS placement that bypass the abdominal fat must be sought. By avoiding the abdominal fat, decreased complications and infection risk may be possible. Objective The objective of this technical document is to describe a laparoscopic approach to the abdominal cavity during ventriculoperitoneal shunt surgery that makes use of a direct tunneling technique into the peritoneal space. Methods We perform a ventriculoperitoneal shunt placement with distal catheter implantation under laparoscopic guidance. Tunneling of the distal abdominal catheter was done through the abdominal fascia directly, without creation of a stab incision for the insertion site. Intraoperative video media was obtained using video footage from OPTIVIEW camera. Results We have found this technique to be feasible and useful for patients with large body habitus. By eliminating the incision overlying the catheter there is decreased risk for infection by skin flora and overall decreased risk of complications. Conclusion Our technique of tunneling directly into the abdominal cavity is both novel and feasible. To our knowledge this is the first time this technique has been described. We believe that further study of this technique in a case series may highlight its advantages in a certain subpopulation of patients requiring VPS.