Laparoscopy-assisted continuous ambulatory peritoneal dialysis catheter placement using Amplatz dilators: a new technique with results.

Abstract

To describe a new modified technique of laparoscopic placement of continuous ambulatory peritoneal dialysis (CAPD) catheters and assess the early results. CAPD catheter implantation was performed in 100 consecutive patients. The technique used laparoscopically guided, extraperitoneal tunneling of the CAPD catheter using Amplatz dilators. The extraperitoneal tunneling helped to maintain the catheter's orientation toward the deep pelvis. Omentopexy was performed on patients with long omentum. Wherever indicated, adhesiolysis was performed to eliminate compartmentalization that could affect the completeness of dialyzate drainage. The average duration of surgery, hospital stay, morbidity, mortality, and catheter survival were assessed. The average operative time was 40 ± 7 minutes, and hospital stay was 3 ± 1 days. There were no conversions from laparoscopy to conventional catheter insertion methods. Exit site or tunnel infections, hemorrhagic complications, abdominal wall hernias, or catheter cuff extrusions were not detected. No patient had either catheter migration or displacement. Peroperative mortality did not occur in this series of patients. Catheter survival was 97% at 6 months. The laparoscopic method described in this report is compliant with consensus guidelines for the best demonstrated practices in peritoneal access placement. Laparoscopy permits direct visualization of all procedure steps in a safe, efficient, and reproducible manner. The use of Amplatz dilators helps in better orientation of the catheter reducing the risk of catheter tip migration.