Laparoscopic Placement of Tenckhoff Catheters for Peritoneal Dialysis: A Safe, Effective, and Reproducible Procedure

Abstract

Currently there are several techniques for laparoscopic placement of peritoneal dialysis catheters. The aim of this paper is to describe our technique and outcomes. Laparoscopic implantation of peritoneal catheters was performed in 100 consecutive patients. The technique employed laparoscopically guided musculofascial tunneling to maintain catheter orientation toward the deep pelvis, and adhesiolysis to eliminate compartmentalization that could affect completeness of dialysate drainage. Mean duration of surgery, hospital stay, morbidity, mortality, and catheter survival were assessed. Analysis of catheter survival was performed using the Kaplan-Meier method, with censoring of catheter loss due to death or successful transplantation. Mean operative time was 20 +/- 7 minutes and average duration of hospital stay was 3 +/- 1 days. There were no conversions from laparoscopy to conventional catheter insertion methods. No exit-site or tunnel infections, hemorrhagic complications, abdominal wall hernias, or catheter cuff extrusions were detected. No mortality occurred in this series of patients. Catheter survival was 97%, 95%, and 91% at 1, 2, and 3 years, respectively. The laparoscopic method described in this report is compliant with consensus guidelines for best-demonstrated practices in peritoneal access placement. Laparoscopy permits direct visualization of all procedure steps in a safe efficient reproducible manner. The laparoscopic approach afforded patients the advantage of short procedure times, a minimally invasive approach, and excellent outcomes. The results reported in this paper support our opinion that laparoscopic Tenckhoff catheter implantation should become the standard of care for clinical practice.