Laparoscopic Peritoneal Research Articles

Laparoscopic-Assisted Peritoneal Access in Ventriculoperitoneal Shunt Placement: Systematic Review and Meta-Analysis.

The most common treatment of hydrocephalus is ventriculoperitoneal (VP) shunting. Peritoneal access is commonly conducted through an open laparotomy, but laparoscopic peritoneal access is gaining popularity. Many studies have reported the benefits of minimally invasive laparoscopic peritoneal access, but there is no consensus on its use. We conducted a systematic review and meta-analysis to compare open laparotomy vs laparoscopic peritoneal access in VP shunting. A systematic search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using 3 databases. Twelve studies included only adults, 3 included only pediatric patients, and 3 included both adults and pediatric patients. Compared with open laparotomy, laparoscopic peritoneal access was associated with a reduction in distal shunt failure (6.1% vs 2.2%, P = .01), operative time (69.4 vs 56.3 minutes, P < .001), and length of stay (LOS) (9.6 vs 7.3 days, P < .001). There were no differences in proximal shunt failure, total shunt failure, intraoperative complications, or infection rate. In the pediatric population, laparoscopic access was associated with a reduced LOS (7.8 vs 5.9 days, P < .001). Heterogeneity was high but explained by the varying study populations and techniques. Laparoscopic peritoneal access for VP shunt insertion is associated with improved outcomes, including reduced distal shunt failure, reduced operative time, and reduced hospital LOS, when compared with open laparotomy and should be considered for shunt insertion. Additional studies are necessary to further determine the benefit of laparoscopic access, especially in the pediatric population.

Insights into the assembly of the neovaginal microbiota in Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome patients

Neovaginas are surgically constructed to correct uterovaginal agenesis in women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome or as part of gender-affirming surgery for transfeminine individuals. Understanding the assembly of the neovaginal microbiota is crucial for guiding its management. To address this, we conducted a longitudinal study on MRKH patients following laparoscopic peritoneal vaginoplasty. Our findings reveal that the early microbial assemblage exhibited stochastic characteristics, accompanied with a notable bloom of Enterococcus faecalis and genital Mycoplasmas. While both the pre-surgery dimple microbiota and the fecal microbiota constituted the primary species pool, the neovaginal microbiota developed into a microbiota that resembled that of a normal vagina at 6–12 months post-surgery, albeit with a bacterial vaginosis (BV)-like structure. By 2–4 years post-surgery, the neovaginal microbiota had further evolved into a structure closely resembling with the homeostatic pre-surgery dimple microbiota. This concords with the development of the squamous epithelium in the neovagina and highlights the pivotal roles of progressive selective forces imposed by the evolving neovaginal environment and the colonization tropism of vaginal species. Notably, we observed that strains of Lactobacillus crispatus colonizing the neovagina primarily originated from the dimple. Since L. crispatus is generally associated with vaginal health, this finding suggests potential avenues for future research to promote its colonization.

Gastric metastasis and peritoneal carcinosis revealing primary breast cancer: an unusual presentation.

Breast cancer is the most frequent cancer among women. Gastrointestinal tract metastases are uncommon and might be misidentified as primary carcinoma.A noteworthy case-study involved 53-year-old-woman complaining from epigastric pain, ascites and overall health decline. Initial investigations were inconclusive, prompting laparoscopic peritoneal biopsies which revealed independent cell proliferation. Subsequently, a second look upper digestive endoscopy showed multiple gastric ulcerations suggestive of gastric carcinoma. Histologic examination confirmed independent cell proliferation with estrogen receptors expression, a characteristic feature of breast carcinoma. Further investigations led to bilateral invasive lobular breast carcinoma diagnosis. Epirubicin cycophosphamide was prescribed after progression under letrozole ribocilib therapy.This case aims to raise awareness among clinicians about the importance of ruling out breast cancer in patients with peritoneal carcinosis and paying attention to digestive symptoms in breast cancer patients with careful gastric endoscopic examination to avoid misdiagnosis.

Suture passer combined with two-hole laparoscopic peritoneal dialysis catheterization in patients undergoing peritoneal dialysis

Background Laparoscopic techniques are being widely applied for peritoneal dialysis (PD) catheter (PDC) placement. The suture passer is a novel fixation tool that aims to reduce catheter migration. We compared the clinical value of the suture passer combined with two-hole laparoscopic PDC placement to open surgical placement by evaluating preoperative and postoperative conditions, as well as the onset of complications in both groups. Methods A retrospective study was conducted including 169 patients who underwent PDC placement surgery from January 2021 to May 2023. Based on the method employed, patients were divided into two groups: the suture passer combined with a two-hole laparoscopy group (SLG) and the open surgical group (SG). Comprehensive patient information, including general data, preoperative and postoperative indicators, peritoneal function after surgery, and the incidence rate of complications, were collected and analyzed. Results The SLG showed a statistically significant decrease in operative time, intraoperative blood loss, and 6-month postoperative drift rate compared to the SG (p < 0.05). No statistically significant differences were observed between the two groups in terms of sex, age, primary disease, hospitalization time, hospitalization costs, preoperative and postoperative examination indicators, peritonitis, and omental wrapping. Conclusions Suture passer combined with two-hole laparoscopic PDC placement, characterized by simplicity and facilitating secure catheter fixation, was deemed safe and effective for patients undergoing PD. It reduces the catheter migration rate and improved surgical comfort. Overall, this technique demonstrates favorable outcomes in clinical practice.

Long term sexual outcomes of Mayer Rokitansky Küster Hauser Syndrome patients after Uncu-modified Davydov procedure.

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome has an incidence of 1 in 4000. The absence of the vagina and uterus results in sexual dysfunction and infertility. The first-line treatment is vaginal dilatation. There exists a number of second-line surgical options including the Uncu-modified Davydov procedure. To determine the complication rate, anatomical outcomes, and long-term sexual outcomes of MRKH syndrome patients after Uncu-modified Davydov procedure. Patients with MRKH syndrome who underwent paramesonephric remnant-supported laparoscopic double-layer peritoneal pull-down vaginoplasty (aka Uncu-modified Davydov procedure) between January 2008 and December 2021. The procedure involves laparoscopic circular dissection of the pelvic peritoneum followed by pulling down, through the opened vaginal orifice, and suturing the vaginal cuff with the support of uterine remnants. The long-term complication rate, anatomical outcomes, and sexual function outcomes (as measured by Female Sexual Function Index (FSFI)) were ascertained. Main Outcome Measures: The long-term complication rate, anatomical outcomes and FSFI survey results. A total of 50 patients with MRKH syndrome underwent the Uncu-modified Davydov procedure between Jan 2008- Dec 2021. There were four perioperative complications: three bladder injuries (6%) and one rectal serosa injury (2%). Four long-term postoperative complications were identified: one vesicovaginal fistula (2%), one recto-vaginal fistula (2%), and two vaginal stenoses (4%). All patients were physically examined at least one year after surgery. The mean vaginal length was 8.4 + 1.9 cm. The mean FSFI score was 31.5 + 3.9 (minimum score of 24, maximum score of 36). Conclusion: The Uncu-modified Davydov procedure has been demonstrated to be a safe and effective treatment option with high female sexual function index scores for patients with MRKH syndrome. The long-term complication rate, anatomical and sexual outcomes of Uncu-modified laparoscopic peritoneal pull-down vaginoplasty were reported in this study. The results indicated that the surgical approach could be used in selective MRKH patients who failed first-line self-dilatation therapy.

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.

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.

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.

Immediate Dialysis After Simultaneous Laparoscopic Peritoneal Dialysis Catheter Placement and Laparoscopic Inguinal Hernia Repair.

Peritoneal dialysis (PD) is an accepted renal replacement therapy for end-stage renal disease (ESRD). Managing inguinal hernia in patients with PD is not standardized. Thus, this study reported the outcomes of simultaneous laparoscopic peritoneal dialysis catheter (PDC) placement and transabdominal preperitoneal (TAPP) repair of inguinal hernia. Thirteen patients with chronic renal disease and inguinal hernia attending a tertiary hospital between May 1, 2016 and June 30, 2021 were evaluated for laparoscopic PDC placement. Concurrent laparoscopic inguinal herniorrhaphy and laparoscopic PDC placement were performed. Dialysate fluid was measured intraoperatively to the level below the incised peritoneum by 1 inch. The inflow and outflow was smooth without leakage. The amount was increased gradually in the two weeks after regular PD was obtained. Laparoscopic PDC was inserted for 13 patients. Ten patients had unilateral hernia and two had bilateral inguinal hernia. Associated paraumbilical hernia was discovered in two patients. The median follow-up was 30 months. The measured safe amount of dialysate fluid intraoperatively was 400 - 600 mL. There was no death, intraoperative complication, or dialysate leakage. Three PDCs were removed owing to noncompliance. No hernia recurrence was observed. Simultaneous laparoscopic PDC placement and laparoscopic repair of inguinal hernia with immediate dialysis is a safe and feasible surgical technique. Utilizing minimally invasive surgery affords PDC placement and inguinal hernia repair simultaneously.

S3328 An Atypical Etiology of Chronic Abdominal Pain: Peritoneal Tuberculosis

Introduction: Peritoneal tuberculosis (TB) is a rare presentation of extra-pulmonary TB, comprising only 5% of extra-pulmonary TB cases. Patients oftentimes present with non-specific complaints and without typical Mycobacterium tuberculosis risk factors. Additionally, diagnostic testing lacks high sensitivity and specificity with further invasive methods frequently necessitated. We present an unusual case of peritoneal TB presenting as non-localized abdominal pain, facilitating insight into this uncommon disease. Case Description/Methods: A 53-year-old female with a past medical history of hypothyroidism presented with joint pain diagnosed as seronegative rheumatoid arthritis and subsequently began treatment with methotrexate and adalimumab for one year. Within the following year, she experienced chronic right lower quadrant (RLQ) abdominal pain, fevers, night sweats, fatigue, and ascites. Extensive work-up revealed a positive QuantiFERON gold TB test. A diagnostic laparoscopy with peritoneal biopsy successively demonstrated elevated CA-125 and large-volume ascites. Mycobacterium tuberculosis PCR and Grocott methenamine silver staining were negative. One of two acid-fast bacillus (AFB) smear and cultures yielded a positive result. Our patient was treated for peritoneal TB. She continued to have several years of chronic RLQ abdominal pain several months after RIPE treatment completion, undergoing a cholecystectomy and three adhesion lysis procedures with mild symptomatic improvement and subsequent worsening thereafter. An operative note highlighted the large amount of adhesions from the patient’s liver to her diaphragm and anterior abdominal wall, appearing similar to Fitz-Hugh-Curtis syndrome. She continues to have chronic abdominal pain and is followed closely by her treatment team. Discussion: Our patient was on immunosuppressive medications and had a history of travel to Mexico, a high TB burden country. Notably, AFB smear and culture has a poor sensitivity for peritoneal TB, oftentimes necessitating laparoscopic peritoneal biopsy for further diagnosis. Our patient was empirically treated for peritoneal TB before AFB culture yielded positive results, given her B symptoms and positive QuantiFERON test. She also had an elevated CA-125 value, which is associated with peritoneal TB and may be used in patients with a negative AFB stain. Our patient experienced recurrent adhesions, an unfortunate and persistent consequence of the inflammatory nature of peritoneal TB.

LAPAROSCOPIC PERITONEAL EXCISION OF ENDOMETRIOSIS IMPROVES IN VITRO FERTILIZATION (IVF) LIVE BIRTH RATES IN WOMEN < 41 YEARS OF AGE WITH DIMINISHED OVARIAN RESERVE

In vitro fertilization (IVF) has become the preferred treatment approach for women with diminished ovarian reserve (DOR). Although there is a high prevalence of endometriosis in this population, data is lacking as it relates to the potential benefits of laparoscopy prior to IVF. The aim of this study is to determine whether laparoscopic peritoneal excision of endometriosis improves IVF live birth rates in women under 41 years of age with DOR.

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.

Comparison of Sheares vaginoplasty, vaginoplasty using acellular porcine small intestinal submucosa graft and laparoscopic peritoneal vaginoplasty in patients with Mayer-Rokitansky-Küster-Hauser syndrome.

The aim of this study is to compare the perioperative, anatomical and functional outcomes of patients with Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS), undergoing Sheares vaginoplasty, vaginoplasty using acellular porcine small intestinal submucosa (SIS) graft or laparoscopic peritoneal (Davydov) vaginoplasty. In this retrospective study, a total of 117 patients with MRKHS undergoing creation of a neovagina from 2017 to 2020 were retrospectively investigated. Comparisons between continuous variables were performed using Student's t-test and between qualitative variables using chi-squared tests. The operative time, return of bowel activity and return to work were the longest in the laparoscopic Davydov group (P < 0.001). The total cost was the highest in the SIS graft group (P < 0.001). The length of the neovagina was 7.9 ± 1.2 cm in the Sheares group, 7.1 ± 0.8 cm in the SIS graft group and 8.1 ± 1.1 cm in the laparoscopic Davydov group. The difference in the length of the neovagina was significant (P < 0.001). There was significant difference in the duration of continuous mould wearing (P < 0.001). There were no significant differences in the total female sexual function index (FSFI) scores or in the satisfaction scores of the male partner among the three groups. Sheares vaginoplasty and the vaginoplasty using SIS graft caused less trauma and provided similar functional results to laparoscopic peritoneal vaginoplasty. However, the patients in the Sheares group and SIS graft group needed to wear the mould for a longer duration post-surgery. Sheares vaginoplasty can provide a valuable and economic alternative method for the creation of a neovagina in patients with MRKHS.

Laparoscopic Peritoneal Pull through Vaginoplasty with Ovarian Hitching to Facilitate Transvaginal Oocyte Retrieval for Mrkh Syndrome

<h3>Study Objective</h3> Video demonstration of laparoscopic peritoneal pull through vaginoplasty using the midline bands and mobilization of ovaries in the pelvis to facilitate transvaginal oocyte retrieval in a case of MRKH. <h3>Design</h3> Interesting case video. <h3>Setting</h3> Lithotomy. <h3>Patients or Participants</h3> Case of MRKH Syndrome. <h3>Interventions</h3> Laparoscopy. Bladder and rectum was dissected away from midline band between the Uterine buds. NeoVagina created vaginally making a U-shaped incision at the perineum. Peritoneal flaps made using the midline band. This band was cut. The vaginal vault opened using a sponge on holder inserted through the neovagina. The right and left peritoneal flaps were pulled down to the introitus to line the anterolateral part of neovagina and stitched at the end, smooth surface facing out. Releasing incisions made around the ureter, to prevent kinking.The rectovaginal peritoneal was brought down and stitched at the introitus to line the posterior surface of vagina. The neoapex made by passing a circumferential suture of the peritoneum. A mould made was inserted in the neovagina. Ovaries were mobilized into the pelvis and hitched in the POD, after making releasing incisions over the infundibulopelvic and the round ligament to facilitate transvaginal oocyte retrieval. <h3>Measurements and Main Results</h3> Post surgery mould kept for 4 days. A vaginal dilator for 3 to 6 months. Tranvaginal oocyte retrieval planned after 12 weeks. Now 6 weeks post-surgery and can use the vaginal dilator 10 hrs/day. <h3>Conclusion</h3> A peritoneal pull through vaginoplasty can be performed for a case of MRKH using the peritoneum covering the midline band for lining the anterolateral surface of neovagina and rectovaginal peritoneal lining the posterior surface of neovagina. Since this patient needs IVF and surrogacy, the oocyte retrieval in a case of MRKH is a challenge since the ovaries are high at the pelvic brim. The ovaries can be mobilized into the pelvis and a tranvaginal oocyte retrieval can be performed.

Laparoscopic Peritoneal Wash Cytology-Derived Primary Human Mesothelial Cells for In Vitro Cell Culture and Simulation of Human Peritoneum.

Peritoneal mucosa of mesothelial cells line the abdominal cavity, surround intestinal organs and the female reproductive organs and are responsible for immunological integrity, organ functionality and regeneration. Peritoneal diseases range from inflammation, adhesions, endometriosis, and cancer. Efficient technologies to isolate and cultivate healthy patient-derived mesothelial cells with maximal purity enable the generation of capable 2D and 3D as well as in vivo-like microfluidic cell culture models to investigate pathomechanisms and treatment strategies. Here, we describe a new and easily reproducible technique for the isolation and culture of primary human mesothelial cells from laparoscopic peritoneal wash cytology. We established a protocol containing multiple washing and centrifugation steps, followed by cell culture at the highest purity and over multiple passages. Isolated peritoneal mesothelial cells were characterized in detail, utilizing brightfield and immunofluorescence microscopy, flow cytometry as well as Raman microspectroscopy and multivariate data analysis. Thereby, cytokeratin expression enabled specific discrimination from primary peritoneal human fibroblasts. Raman microspectroscopy and imaging were used to study morphology and biochemical properties of primary mesothelial cell culture compared to cryo-fixed and cryo-sectioned peritoneal tissue.

When and how should peritoneal endometriosis be operated on in order to improve fertility rates and symptoms? The experience and outcomes of nearly 100 cases

PurposeTo analyze the follow-up results of patients suffering from symptomatic early-stage endometriosis after a consistent laparoscopic peritoneal stripping of the altered peritoneum (peritoneal endometriosis and surrounding inflamed tissue) was performed. This type of endometriosis is resistant to medical therapy and/or impairs fertility.MethodsUsing our prospectively maintained database, we were able to identify all symptomatic women with the suspicion of only peritoneal endometriosis who underwent laparoscopy at our endometriosis center over a period of 5 years. All procedures were carried out in a standardized fashion by one single surgeon, who is highly experienced in minimal invasive surgery, and included a suspended hormonal pretreatment for 2 months. Postoperative outcomes including complications, fertility and recurrence rates were analysed.ResultsLaparoscopic peritonectomy was performed on 94 women. Follow-up data were available in 87% of these cases. At the time of surgery, almost all patients tested showed signs of stage I or II endometriosis (44.7 and 48.9%, respectively). More than three-quarters of the women reported pain relief, inter alia, due to the post-surgical hormonal therapy. About one-third of the patients wanted to have children after the procedure. 62% of them became pregnant and the majority did so without the need for assisted reproductive therapy. In seven women a re-operation was performed.ConclusionAccording to our data, a consistent excision of altered peritoneum followed by adjuvant hormonal therapy and multimodal concepts results in better outcomes for the patient, particularly in regards to pregnancy and recurrence rates.

Outcomes of Laparoscopic Peritoneal Dialysis Catheter Placement Using an Optimal Placement Technique.

Background:Peritoneal dialysis (PD) is a widely employed renal replacement modality. A prospective study was conducted to determine the short-term and midterm outcomes and complication rates associated with a standardized optimal laparoscopic peritoneal dialysis catheter placement technique.Methods:All patients undergoing laparoscopic PD catheter placement by one surgeon using our standardized method over a 5-year period were entered into a prospective database. Patients were evaluated preoperatively and postoperatively through office visits. Development of complications was assessed using follow up telephone or mail surveys.Results:A total of 100 patients with a mean age of 56 years underwent laparoscopic PD catheter placement over the 5-year study period. In total, 103 laparoscopic PD catheter placement attempts were made in 100 patients. Placement was successful in 98 (95.1%) attempts and no placement required conversion to an open operation. Omentopexy was performed in 82 (83.7%) patients. There was no mortality reported within 30 days of the index operation. For patients who successfully underwent laparoscopic PD placement, early complications developed in 9 (9.2%) patients, of which 6 (6.1%) complications were directly related to the PD catheter. Midterm complications developed in 25 (25.5%) patients. Complication-related catheter repositioning was required for 12 (12.2%) catheters and catheter-related complication removal was required for 18 (18.4%) catheters.Conclusion:Laparoscopic placement of PD catheters can be successfully performed using a combination of described standardized laparoscopic maneuvers for optimal placement resulting in acceptable perioperative and short and midterm complication rates with negligible mortality rates.

A modified laparoscopic peritoneal dialysis insertion technique, the 'one scar technique' can minimise short and long term complications: A retrospective cohort study.

Peritoneal dialysis is a renal replacement therapy that has advanced in technique over the last few decades. In this study, we describe a novel method for laparoscopic peritoneal dialysis catheter insertion and fixation and compare its outcome to standard laparoscopic insertion technique with better cosmetic outcome. Peri-operative and follow up data was collected retrospectively for 184 patients undergoing peritoneal dialysis catheter insertion from September 2012 to September 2018. The post-modification technique showed no difference in catheter blockage rates, incisional hernia or catheter replacement rates. A significant difference was found in catheter migration rate and exit site infections and overall complication rates, found to be lower using the new technique. A modification of the laparoscopic peritoneal dialysis technique is superior to standard laparoscopic insertion with a cosmetically more appealing outcome due to one visible.

Urogynecology

Urogynecology

New Approach to Laparoscopic Peritoneal Pull through Vaginoplasty

Video Objective To evaluate the outcome of new technique of laparoscopic peritoneal pull through vaginoplasty. Setting Tertiary referral centre (Tulip Multispeciality Hospital). Interventions The peritoneum was mobilized as much as possible from all around lateral pelvic wall we applied 4 stay sutures to the mobilized peritoneum (ant, post, Rt, Lt) and the same sutures were pulled through the vagina and tied to the introitus. Conclusion Our technique appears to be an effective and safe surgical management option giving excellent normal vaginal function and patient satisfaction score was good.