Laparoscopic Peritoneal Dialysis Catheter Insertion Research Articles

948 Learning Curve for Single Surgeon Approach of Laparoscopic Peritoneal Dialysis Catheter Insertion Using Freehand Robotic Assistant

Abstract Introduction A single surgeon approach to laparoscopic peritoneal dialysis catheter insertion can offer improved efficiency to surgical lists as well as freeing up surgeons to complete other operations or ward jobs. Simple, low risk laparoscopic procedures which can be completed quickly with the aid of a robotic assistant can help hospitals improve efficiency of surgical departments. This study aims to assess the learning curve of a single surgeon approach using the Freehand robotic assistant in peritoneal dialysis catheter insertion. Method Seventy-two cases were analysed over a period of three years from 2020-2023, operations involving the Freehand robotic assistant were performed by a single consultant surgeon. The duration of the procedure was one of the main factors evaluated for assessing learning curve. Other factors considered were re-do procedures and post-operative complications. Results Total mean operating time was 30.23 minutes. The peak point of the CUSUM chart for operating time was found at case 30, from this point onward trend began to decrease. From the 72 cases 6 had post-operative complications due to peritonitis and 2 had to be re-done due to inadequate positioning. Conclusions CUSUM chart indicated proficiency was gained at operation 30. There were minimal replacements necessary and only 6 cases that had post-operative complications all within the first 25 operations. This implies a short learning curve with great potential for improving efficiency with the use of the Freehand robot in simple laparoscopic procedures such as peritoneal dialysis catheter insertion.

Laparoscopic peritoneal dialysis catheter insertion with omentopexy-sparing the omentum in children.

Continuous ambulatory peritoneal dialysis is an important modality of renal replacement therapy in children. Catheter dysfunction (commonly obstruction) is a major cause of morbidity and is a significant concern that hampers renal replacement therapy. As omentum is a significant cause of obstruction, some recommend routine omentectomy during insertion of the peritoneal dialysis catheter. Omentopexy rather than omentectomy has been described in adults to spare the omentum as it may be needed as a spare part in many conditions. Laparoscopic approach is commonly preferred as it provides global evaluation of the peritoneal space, proper location of the catheteral end in the pelvis and lesser morbidity due to inherent minimally invasive nature. The aim of this study is to present the technique of laparoscopic peritoneal dialysis catheter placement in children with concurrent omentopexy. We retrospectively evaluated our patients who underwent laparoscopic placement of peritoneal dialysis catheter with concomitant omentopexy or omentectomy. A total of 30 patients were enrolled who received either omentectomy (n = 18) or omentopexy (n = 12). Four catheters were lost in the omentopexy group (33%) and 3 in the omentectomy group (17%), but none were related to omental obstruction. Three out of 4 patients in the omentopexy group and 2 out of 3 patients in the omentectomy group had a previous abdominal operation as a potential cause of catheter loss. Previous history of abdominal surgery was present in 6 patients (50%) in the omentopexy group and 3 patients (17%) in the omentectomy group. As omentum was associated with catheter failure, omentectomy is commonly recommended. Alternatively, omentopexy can be preferred in children to spare an organ that may potentially be necessary for many surgical reconstructive procedures in the future. Laparoscopic peritoneal dialysis catheter placement with concomitant omentopexy appears as a feasable and reproducible technique. Although the catheter loss seems to be higher in the omentopexy group, none was related with the omentopexy procedure and may be related to the higher rate of history of previous abdominal operations in this group.

The Association of Intra-Abdominal Adhesions with Peritoneal Dialysis Catheter-Related Complications.

This study investigated the association of intra-abdominal adhesions with the risk of peritoneal dialysis (PD) catheter complications. Individuals undergoing laparoscopic PD catheter insertion were prospectively enrolled from eight centers in Canada and the United States. Patients were grouped based on the presence of adhesions observed during catheter insertion. The primary outcome was the composite of PD never starting, termination of PD, or the need for an invasive procedure caused by flow restriction or abdominal pain. Seven hundred and fifty-eight individuals were enrolled, of whom 201 (27%) had adhesions during laparoscopic PD catheter insertion. The risk of the primary outcome occurred in 35 (17%) in the adhesion group compared with 58 (10%) in the no adhesion group (adjusted HR, 1.64; 95% confidence interval [CI], 1.05 to 2.55) within 6 months of insertion. Lower abdominal or pelvic adhesions had an adjusted HR of 1.80 (95% CI, 1.09 to 2.98) compared with the no adhesion group. Invasive procedures were required in 26 (13%) and 47 (8%) of the adhesion and no adhesion groups, respectively (unadjusted HR, 1.60: 95% CI, 1.04 to 2.47) within 6 months of insertion. The adjusted odds ratio for adhesions for women was 1.65 (95% CI, 1.12 to 2.41), for body mass index per 5 kg/m 2 was 1.16 (95% CI, 1.003 to 1.34), and for prior abdominal surgery was 8.34 (95% CI, 5.5 to 12.34). Common abnormalities found during invasive procedures included PD catheter tip migration, occlusion of the lumen with fibrin, omental wrapping, adherence to the bowel, and the development of new adhesions. People with intra-abdominal adhesions undergoing PD catheter insertion were at higher risk for abdominal pain or flow restriction preventing PD from starting, PD termination, or requiring an invasive procedure. However, most patients, with or without adhesions, did not experience complications, and most complications did not lead to the termination of PD therapy.

The clinical implications of occult inguinal hernia identified during laparoscopic peritoneal dialysis catheter insertion.

Occult inguinal hernias predispose patients undergoing peritoneal dialysis (PD) to symptomatic inguinal hernia formation causing complications. We conducted a retrospective study to assess the usefulness of routine laparoscopic examination for occult inguinal hernia during PD catheter insertion and the risk profile of occult inguinal hernia according to hernia classification in patients with PD. This study included 79 patients who underwent initial laparoscopic PD catheter insertion between 2021 and 2022. An occult hernia was defined as an internal hernial sac of all sizes that was not detectable on physical examination. The European Hernia Society groin hernia classification was used to describe the hernia type. We investigated the association between event-free survival and occult inguinal hernias in patients undergoing PD. Occult inguinal hernias were diagnosed in 24 (32%) patients. Among these patients, 5 (21%) patients underwent metachronous repair. In patients with L2 occult hernias, the cumulative incidence rates of right and left symptomatic hernias within one year were 100% and 50%, respectively. Multivariate analysis revealed that L2 occult hernias were associated with metachronous hernia repair. The L2 occult inguinal hernia during PD was associated with metachronous repair, suggesting the importance of routine examination of inguinal hernias during laparoscopic PD catheter insertion.

Modified Single Port Laparoscopic Peritoneal Dialysis Catheter Insertion - Initial Experience and Outcome from a Tertiary Care Centre

Background: Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are emerging as a major health related issues in developing countries. The increasing numbers require rapid adaptation of existing health-care policies. The number of patients requiring renal care is only bound to increase in coming years with the increasing incidence and prevalence of diabetes. Continuous ambulatory peritoneal dialysis (CAPD) catheter placement is performed on end-stage renal disease (ESRD) patients. There is abundant literature regarding post-operative outcomes and re-operative rates following CAPD. We report our initial experience of modified single port laparoscopic technique of placing CAPD catheters using a single port through the Palmer’s point and discuss our surgical outcomes. Methods: This was a retrospective review (2019-2020) of patients undergoing CAPD catheter placement at SMVD Narayana Superspecialty Hospital. Outcome analysis focused on patient related outcomes, including early (< 30 days) versus late (≥ 30 days) complication and re-operation rates. Results: A total of 30 patients with ESRD, (mean ASA score = 3.3) were included in the study who underwent modified single port laparoscopic (n = 30) CAPD catheter placement (mean follow-up = 180 days). The total complication rate with the procedure was 43%, with re-operation rate of 20%. CAPD catheter non-function occurred in 06 patients (20% of total). CAPD catheter migrations occurred in 03 patients (10% of total). CAPD catheter related infections occurred in 05 patients (16% of total), and 02 required re-operation; 03 patients were treated successfully with culture directed antibiotics. There were 2 deaths during the study period, one due to peritonitis and other due to underlying cardiac disease. There was no surgical mortality in the study group. Conclusion: Although CAPD catheter placement in patients with ESRD are technically un-complicated to accomplish, long term results suggest as many as one in three patients will struggle with some form of catheter malfunction or infection. Our modified technique and the results have led to changes in our CAPD catheter placement technique, as well as the post-operative patient care algorithm.

Nephroscope-assisted single trocar peritoneal dialysis catheter insertion improves catheter survival compared with laparoscopic technique: Ten-year experience of a single-center

BackgroundAn ideal technique for peritoneal dialysis (PD) catheter insertion should provide a long-term functioning catheter until permanent renal replacement therapy becomes available. We developed a technique using the nephroscope-assisted single-trocar approach in 2011. In this study, we report the outcomes, learning curve analysis and cost-effectiveness analysisof the nephroscopic approach compared with the traditional laparoscopic approach. MethodBetween January 2005 and December 2020, we retrospectively reviewed 511 patients who received PD catheter insertions using the laparoscopic or nephroscopic approach. We compared the baseline characteristics of the patients, surgical outcomes, and complications of the two groups. We further analyzed the nephroscopic group to determine the cost-effectiveness analysis, learning curve and the complication frequency between the learning and mastery periods of the nephroscopic approach. ResultsA total of 208 patients underwent laparoscopic PD catheter insertion, whereas 303 patients received nephroscopic surgery. The median catheter survival in the nephroscopic group is significantly longer (43.1 vs. 60.5 months, p = 0.019). The incidence of peritonitis (29.3% vs.20.8%, p = 0.035) and exit site infection (12.5% vs. 6.6%, p = 0.019) were significantly lower in the nephroscopic group. The cost-effectiveness analysis showed a medical expense reduction of 16000 USD annually by using the nephroscopic technique. There was no difference in the frequency of surgical complications between the learning and mastery phases when examining the learning curve analysis for the nephroscopic technique. ConclusionsCompared with the traditional laparoscopic approach, the nephroscopic technique effectively prolonged catheter survival and reduces health care cost by reducing infectious complications. The low complication rate during the learning phase of surgery makes the procedure safe for patients and surgeons.

Assessment of potential peritonitis risk factors in pediatric patients receiving maintenance peritoneal dialysis.

Many recommendations regarding peritonitis prevention in international consensus guidelines are opinion-based rather than evidence-based. The aim of this study was to examine the impact of peritoneal dialysis (PD) catheter insertion technique, timing of gastrostomy placement, and use of prophylactic antibiotics prior to dental, gastrointestinal, and genitourinary procedures on the risk of peritonitis in pediatric patients on PD. We conducted a retrospective cohort study of pediatric patients on maintenance PD using data from the SCOPE collaborative from 2011 to 2022. Data pertaining to laparoscopic PD catheter insertion (vs. open), gastrostomy placement after PD catheter insertion (vs. before/concurrent), and no prophylactic antibiotics (vs. yes) were obtained. Multivariable generalized linear mixed modeling was used to assess the relationship between each exposure and occurrence of peritonitis. There was no significant association between PD catheter insertion technique and development of peritonitis (aOR = 2.50, 95% CI 0.64-9.80, p = 0.19). Patients who had a gastrostomy placed after PD catheter insertion had higher rates of peritonitis, but the difference was not statistically significant (aOR = 3.19, 95% CI 0.90-11.28, p = 0.07). Most patients received prophylactic antibiotics prior to procedures, but there was no significant association between prophylactic antibiotic use and peritonitis (aOR = 1.74, 95% CI 0.23-13.11, p = 0.59). PD catheter insertion technique does not appear to have a significant impact on peritonitis risk. Timing of gastrostomy placement may have some impact on peritonitis risk. Further study must be done to clarify the effect of prophylactic antibiotics on peritonitis risk. A higher resolution version of the Graphical abstract is available as Supplementary information.

Minimally Invasive Peritoneal Dialysis Catheter Insertion with Intraoperative Ultrasound-Doppler Measurement of Rectus Muscle Width and Inferior Epigastric Artery Localization

Laparoscopic peritoneal dialysis catheter insertion is an established method for peritoneal dialysis catheter placement. One critical aspect of this procedure is rectus sheath tunneling. Proper peritoneal dialysis catheter incorporation within the abdominal wall is important for reducing pericatheter leaks and for proper peritoneal dialysis functioning. Particularly, accurate positioning of the internal cuff within the rectus muscle sheath is crucial to prevent potential dialysate fluid leakage. In the present report, we describe the utilization of intraoperative ultrasound as a valuable tool for determining the ideal location of the internal cuff and assessing the course of the inferior epigastric artery during rectus sheath tunneling. This technique aims to optimize the position of the internal cuff and minimize complications such as vessel injury and pericatheter leaks. Furthermore, we demonstrate that post-catheter insertion, ultrasound imaging offers valuable insights into evaluating the appropriate placement of the internal cuff, external subcutaneous cuff, and potential bleeding within the abdominal wall.

A Service Reconfiguration Bundle for Expanding Access to Peritoneal Dialysis Including for Older Frailer Patients.

Rates of peritoneal dialysis (PD) have been traditionally low in Northern Ireland. With rising numbers of patients reaching end-stage kidney disease, PD is a more cost-effective treatment than haemodialysis and aligns with international goals to increase home-based dialysis options. The aim of our study was to highlight how a service reconfiguration bundle expanded access to PD in Northern Ireland. The service reconfiguration bundle consisted of the appointment of a surgical lead, a dedicated interventional radiologist for fluoroscopically guided PD catheter insertion, and a nephrology-led ultrasound-guided PD catheter insertion service in an area of particular need. All patients in Northern Ireland who had a PD catheter inserted in the year following service reconfigurations were included and prospectively followed up for one-year. Patient demographics, PD catheter insertion technique, setting of procedure, and outcome data were summarised. The number of patients receiving PD catheter insertion doubled to 66 in the year following service reconfigurations. The range of approaches to PD catheter insertion (laparoscopic n = 41, percutaneous n = 24 and open n = 1) allowed a wide range of patients to benefit from PD. Six patients had emergency PD catheter insertion, with four receiving urgent or early start PD. Nearly half (48%, 29/60) of the PD catheters inserted electively were in smaller elective hubs rather than the regional unit. A total of 97% of patients successfully started PD. Patients who experienced percutaneous PD catheter insertion were older [median age 76 (range 37-88) vs. 56 (range 18-84), p < 0.0001] and had less previous abdominal surgery than patients who experienced laparoscopic PD catheter insertion (25%, 6/24 vs. 54%, 22/41, p = 0.05). Through a service reconfiguration bundle, we were able to double our annual incident PD population. This study highlights how flexible models of service delivery introduced as a bundle can quickly deliver expanded access to PD and home therapy.

Laparoscopic peritoneal dialysis catheter insertion: an oasis harnessed-experience and results at a tertiary care centre in India.

Peritoneal dialysis is a life sustaining renal replacement therapy for patients with end stage renal disease. In comparison to hemodialysis it offers better mobility and independence to patients. A number of techniques including open, laparoscopic and fluoroscopy guided, and their modifications, have been described for intraperitoneal catheter insertion. We describe our technique and results of laparoscopic peritoneal dialysis (PD) catheter insertion at a tertiary care centre in India. 48 patients were referred from the department of nephrology at our centre for laparoscopic PD catheter insertion. A two port technique was used in 37 patients and three port technique was implemented in the rest for simultaneous adhesiolysis and/or omentectomy. A straight tip catheter was tunneled through the rectus muscle in all patients. Two patients had incisional hernia from a previous abdominal surgery which was repaired concomitantly with onlay meshplasty. The operative time ranged between 20 and 35min under general anaesthesia. Three patients were subjected to urgent start dialysis of which one patient developed peridrain leak as an early complication which was managed conservatively. All other patients were commenced on peritoneal dialysis two weeks after surgery. There was no other surgical site occurrence or episodes of peritonitis reported in a 6month follow up period with the department of nephrology. In the era of minimal access surgery, the laparoscopic approach is feasible for widespread and safe use for PD catheter insertion. The benefits of PD can thus be made available to patients at civil hospitals even with a basic laparoscopy setup.

Clinical Benefits of Laparoscopic Adhesiolysis during Peritoneal Dialysis Catheter Insertion: A Single-Center Experience.

Background and Objectives: In peritoneal dialysis (PD) therapy, intra-abdominal adhesions (IAAs) can cause catheter insertion failure, poor dialysis function, and decreased PD adequacy. Unfortunately, IAAs are not readily visible to currently available imaging methods. The laparoscopic approach for inserting PD catheters enables direct visualization of IAAs and simultaneously performs adhesiolysis. However, a limited number of studies have investigated the benefit/risk profile of laparoscopic adhesiolysis in patients receiving PD catheter placement. This retrospective study aimed to address this issue. Materials and Methods: This study enrolled 440 patients who received laparoscopic PD catheter insertion at our hospital between January 2013 and May 2020. Adhesiolysis was performed in all cases with IAA identified via laparoscopy. We retrospectively reviewed data, including clinical characteristics, operative details, and PD-related clinical outcomes. Results: These patients were classified into the adhesiolysis group (n = 47) and the non-IAA group (n = 393). The clinical characteristics and operative details had no remarkable between-group differences, except the percentage of prior abdominal operation history was higher and the median operative time was longer in the adhesiolysis group. PD-related clinical outcomes, including incidence rate of mechanical obstruction, PD adequacy (Kt/V urea and weekly creatinine clearance), and overall catheter survival, were all comparable between the adhesiolysis and non-IAA groups. None of the patients in the adhesiolysis group suffered adhesiolysis-related complications. Conclusions: Laparoscopic adhesiolysis in patients with IAA confers clinical benefits in achieving PD-related outcomes comparable to those without IAA. It is a safe and reasonable approach. Our findings provide new evidence to support the benefits of this laparoscopic approach, especially in patients with a risk of IAAs.

POST-OPERATIVE OUTCOME OF LAPAROSCOPIC PERITONEAL DIALYSIS CATHETER INSERTION/SALVAGE BY THE “SANTOSH-PGI HANGING LOOP TECHNIQUE”: RESULTS FROM A TERTIARY CARE SINGLE-CENTRE EXPERIENCE

Objectives: To analyse post-operative outcomes and gauge the operative efcacy in 17 patients undergoing laparoscopic peritoneal dialysis catheter insertion by the “Santosh-PGI Hanging Loop Technique”. From 2015-2022, patients unde Patients &amp; Methods: rgoing laparoscopic peritoneal dialysis catheter insertion/salvage by the “Santosh-PGI Hanging Loop Technique” was retrieved from the institutional database. Details regarding surgical outcomes were analysed. During the study period, 17 patients having Results: end-stage kidney disease, underwent laparoscopic peritoneal dialysis catheter insertion/salvage by the “Santosh-PGI Hanging Loop Technique”. The mean postoperative follow-up period was 16.33 (1-53) months. At the end of the follow-up period, 1(5.88%) catheter had malfunctioned/migrated, 5(29.41%) patients had died (due to unrelated causes; catheters were functional at the time of demise), and 11(64.70%) were functioning well. 9(52.94%) patients were salvage cases (operated outside initially, by other surgeons) and all had functional catheters at the end of the follow-up period. All cases were operated by a single surgeon. Altogether, we found a success rate of more than 90 %. Patients Conclusion: undergoing laparoscopic peritoneal dialysis catheter insertion/salvage by the “Santosh-PGI Hanging Loop Technique” have a high rate of functioning catheters, ultimately leading to an improved survival rate and patient satisfaction, in patients with end-stage renal disease.

Perioperative management of patient with pre-existing deep vein thrombosis for laparoscopic peritoneal dialysis catheter insertion: a case report

BackgroundA patient with chronic kidney disease and recurrent catheter-related thrombosis.Case presentationThe patient had femoral vein thrombosis and was scheduled for laparoscopically assisted continuous ambulatory peritoneal dialysis catheter insertion. The chief concerns during the perioperative period were the risk of pulmonary thromboembolism, limited venous access, and risk of bleeding as the patient was on anticoagulation therapy. Meticulous attention was paid to history, clinical examination, and to the ongoing treatment with regard to risk of systemic thrombosis.ConclusionsManagement was tailored according to risk of thrombosis and bleeding during perioperative period along with identification adverse events associated with anticoagulation and preparedness for management of pulmonary embolism.

Catheter insertion techniques for improving catheter function and clinical outcomes in peritoneal dialysis patients.

Catheter insertion techniques for improving catheter function and clinical outcomes in peritoneal dialysis patients.

Modified minimally invasive laparoscopic peritoneal dialysis catheter insertion with internal fixation

Background Laparoscopic technique is widely used in peritoneal dialysis (PD) catheter placement. We developed a modified minimally invasive laparoscopic PD catheter (PDC) insertion with internal fixation and evaluated the early results by observing the intraoperative and postoperative conditions of the novel technique with those of conventional open surgery. Methods Retrospective research was performed on 59 patients who underwent PDC insertion from June 2019 to January 2022, including 23 patients who received open surgery and 36 patients who received modified minimally invasive laparoscopic surgery. Information such as preoperative conditions, operation time, incision length, incidence of intraoperative complications, time from operation to starting PD, time from operation to discharge, and incidence of catheter-related complications were collected and analyzed. Results The incision length, intraoperative blood loss, catheter migration rates and the total incidence of complications 6 months after operation in the laparoscopic group were lower than those in the conventional group. There were no statistically significant differences between the two groups in operation time, time from operation to starting PD, time from operation to discharge and the incidence of catheter blockage, leakage, exit-site infection, peritoneal dialysis associated peritonitis and hernia. Conclusions Modified minimally invasive laparoscopic PDC insertion and internal fixation method achieved direct vision and reliable fixation of the catheter, significantly reduced incision length and blood loss. The incidence of catheter migration was significantly lower than that of open surgery. Our primary findings reveal that modified minimally invasive laparoscopic PDC insertion with internal fixation is safe, effective and beneficial for PD patients.

Radiological versus laparoscopic insertion of peritoneal dialysis catheter: a study comparing outcomes at a single centre.

Although peritoneal dialysis (PD) is a well-established and effective form of renal replacement therapy in end-stage renal failure (ESRF) patients, there is no consensus as to the optimal insertion technique. This study compares the outcomes of PD catheters inserted radiologically versus laparoscopically at a single centre. Patients who underwent either radiological PD catheter insertion (RC) or laparoscopic insertion (LC) between 2013 and 2019 were retrospectively reviewed. Primary outcome was catheter patency at 12 months. Secondary outcomes included exit-site infections, peritonitis, and pericatheter leaks within 30 days of insertion, any complications associated with insertion, overall catheter survival, and inpatient length of stay (LoS). There were 81 patients included in this study, with a total of 100 procedures performed (RC=48, LC=52). There were significantly fewer overall complications in the LC group compared to the RC group (P< 0.001). However, when individual complications were considered, this significant difference was only seen in the rate of malpositioned catheters (10.4% versus 0%, P= 0.023). Hospital LoS was longer in the LC group compared to the RC group (3 versus 2 days, P= 0.004), but this was outweighed by the fact that there were more laparoscopically inserted PD catheters still functioning and patent at 12 months compared to those inserted radiologically. This study has demonstrated that our laparoscopic PD catheter insertion technique of securing the catheter tip low in the pelvis is safe and effective, providing a lower complication rate and longer-term viability when compared to the radiological percutaneous approach.

A novel technique of sutureless omentopexy during dual-incision laparoscopic peritoneal dialysis catheter insertion to prevent catheter dysfunction due to omental wrapping.

Omental wrapping (OW) is the leading cause of obstruction of the peritoneal dialysis (PD) catheter, which interferes with dialysis treatment. Routinely or selectively performing omentopexy during laparoscopic PD catheter placement has been suggested to prevent OW. However, most of the published techniques for performing this adjunctive procedure require additional incisions and suturing. Herein, we aimed to report our experience in performing omentopexy with a sutureless technique during dual-incision PD catheter insertion. We also performed a comparative analysis to assess the benefit/risk profile of routine omentopexy in these patients. This retrospective study enrolled 469 patients who underwent laparoscopic PD catheter insertion. Their demographic characteristics and operative details were collected from the database of our institution. Omentopexy was performed by fixing the inferior edge of the omentum to the round ligament of the liver using titanium clips. For analysis, the patients were divided into the omentopexy group and the non-omentopexy group. We also reviewed the salvage management and outcomes of patients who experienced OW. The patients were categorized into the omentopexy (n = 81) and non-omentopexy (n = 388) groups. The patients in the non-omentopexy group had a higher incidence of OW, whereas no patient in the omentopexy group experienced this complication (5.2% vs. 0.0%, p = 0.033). The median operative time was 27min longer in patients who underwent omentopexy than in those who did not [100 (82-118) min vs. 73 (63-84) min, p < 0.001]. One patient had an intra-abdominal hematoma after omentopexy and required salvage surgery to restore catheter function. The complication rate of omentopexy was 1.2% (1/81). Sutureless omentopexy during laparoscopic PD catheter insertion is a safe and reliable technique that does not require additional incisions and suturing. Routinely performing omentopexy provides clinical benefits by reducing the risk of catheter dysfunction due to OW.

Does Laparoscopic Omentectomy Reduce CAPD Catheter Malfunction: A Three-arm Pilot Randomized Trial.

Introduction:Catheter malfunction secondary to omental wrapping is a frequent complication of continuous ambulatory peritoneal dialysis (CAPD). Of the various methods of peritoneal dialysis catheter insertion (PDCI), open surgical insertion under local anesthesia is most widely practiced. Laparoscopic omentectomy is often undertaken as a salvage procedure in case of malfunctioning catheters. However, there is no randomized controlled trial (RCT) to evaluate the role of prophylactic laparoscopic omentectomy on catheter function. This pilot RCT was undertaken to evaluate the impact of laparoscopic omentectomy on the incidence of catheter malfunction.Materials and Methods:Consecutive patients were randomized into three groups: laparoscopic PDCI with omentectomy (Group A), laparoscopic PDCI without omentectomy (Group B) and open surgical PDCI (Group C). The primary outcome was the incidence of catheter malfunction at 6 weeks and 3 months.Results:Forty-one patients completed follow-up, with 16, 11, and 14 patients in Groups A, B, and C, respectively. Incidence of catheter malfunction was 6.2%, 27.3%, and 14.3% in Groups A, B, and C, respectively, at 6 weeks and 6.2%, 36.4%, and 21.4% at 3 months, respectively. In patients with previously failed catheter insertion (n = 23), malfunction at 3 months was 8.3% (1/12) in patients who had omentectomy, compared with 45.5% (5/11) in those who did not (P = 0.069). Operating time was significantly higher (P < 0.001) in Group A.Conclusions:Laparoscopic omentectomy may be associated with a lower incidence of catheter malfunction, especially in patients with previously failed peritoneal dialysis catheter. Data from this pilot RCT can be used to design a large trial with an adequate number of patients.

Surgical early complications of the laparoscopic insertion of peritoneal dialysis catheter: A cross-sectional descriptive two-center study in Ahvaz, southwest of Iran

Objectives: This study aimed to investigate the surgical complications of this technique of peritoneal dialysis catheter insertion in Imam Khomeini and Golestan hospitals in Ahvaz, southwest of Iran, in the period between 2007 and 2019. Methods: In this retrospective cross-sectional analytic-descriptive study, we examined end-stage renal disease (ESRD) patients who underwent laparoscopic peritoneal dialysis catheter insertion between 2007 and 2019. Patients' records and follow-up information recorded in the hospital dialysis unit were reviewed and early infectious and mechanical complications of peritoneal dialysis catheter insertion were analyzed. Results: In this study, 290 patients (144 males and 138 females) with ESRD who have a mean age of 46±19.7 years (1-90 years) were recruited, of whom 8 patients were excluded due to incomplete information in their records, and 68 patients (24.1%) had an early complication of surgery. Surgical complications included: Catheter exit-site infections in 20 patients (7.1%), peritonitis in 18 patients (6.4%), catheter exit-site leakage in 17 patients (6%), catheter occlusion without migration in 16 patients (5.7%), catheter migration in 7 patients (2.5%), and hemoperitoneum in 7 patients (2.5%). Conclusions: Due to the low complications of laparoscopic surgery in the insertion of a peritoneal dialysis catheter, this technique is recommended as a safe surgical procedure with low complications.

Percutaneous insertion of peritoneal dialysis catheters by the nephrologist (modified Seldinger technique)

A proper functioning access to the peritoneal cavity is the first and foremost requirement to start peritoneal dialysis. Most commonly, peritoneal dialysis catheters are inserted using a surgical approach. Laparoscopic peritoneal dialysis catheter insertion is the recommended surgical technique because it offers to employ advanced adjunctive procedures that minimize the risk of mechanical complications. In patients with low risk of mechanical catheter complications, such as patients without prior history of abdominal surgery or peritonitis, and in patients ineligible for general anesthesia, the percutaneous approach of peritoneal dialysis catheter insertion is an alternative to surgical catheter insertion. Percutaneous insertion of peritoneal dialysis catheters can be performed by a dedicated nephrologist, interventional radiologist, surgeon or nurse practitioner under local anesthesia, either with or without image guidance using ultrasound or fluoroscopy. Several reports show similar catheter function rates, mechanical and infectious complications and catheter survival for percutaneously inserted peritoneal dialysis catheters compared to surgically inserted peritoneal dialysis catheters. This article describes the percutaneous insertion of peritoneal dialysis catheters technique adopted at Universitair Ziekenhuis Brussel since 2015. Our technique is a simple low-tech modified Seldinger procedure performed by the nephrologist and not using fluoroscopy guidance. We describe the excellent outcomes of our percutaneously inserted peritoneal dialysis catheters and offer a practical guide to set up your own percutaneous catheter insertion program.