Laparoscopic peritoneal catheter placement: Results of a new method in 111 patients

Raymond D. Turner, Steven M. Rosenblatt, Bipan Chand, Mark Luciano

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: Although cerebrospinal fluid shunting remains one of the most common neurosurgical procedures, it is fraught with high infection, blockage, and reoperation rates. It has been estimated that the economic cost of ventriculoperitoneal shunting exceeds $1 billion annually. A new laparoscopic technique that eliminates abdominal incisions overlying shunt hardware was applied to 111 patients requiring ventriculoperitoneal shunts in an effort to decrease the morbidity associated with shunting. METHODS: All patients who required ventriculoperitoneal shunt insertion were eligible for this surgical technique. Patient selection was based on availability of both surgical teams (general surgery and neurological surgery) at the time of surgery. Using this technique, the distal shunt catheter is tunneled directly from the head into the peritoneal cavity under laparoscopic guidance without a skin incision directly overlying the distal catheter insertion site. Patients were followed prospectively for signs and symptoms related to shunt dysfunction, shunt infection, and incision morbidity. RESULTS: One hundred eleven patients underwent 113 laparoscopic ventriculoperitoneal shunt surgeries between February 2003 and December 2004. The average follow-up period was 21.7 months (range, 12-34 mo). Nearly half of the patients (49%) were discharged the next morning and the majority (81%) was discharged within 2 days of surgery. Overall, 15 patients experienced complications requiring reoperation (13.5%) with a 1-year shunt survival rate of 91%. One patient (0.9%) acquired a new shunt infection, whereas two patients (1.8%) developed recurrence from a previous shunt infection. There were no abdominal incision-related complications. CONCLUSION: This simplified laparoscopic shunt placement technique, which requires no overlying abdominal incisions, can be performed quickly with high shunt survivability and low infection rates. Furthermore, the laparoscopic method has the advantage of fast recovery time, elimination of preperitoneal or misplaced catheters, and decreased abdominal incision morbidity. The procedure can be performed by either a multidisciplinary team or entirely by neurosurgeons.

Original languageEnglish (US)
JournalNeurosurgery
Volume61
Issue number3 SUPPL.
DOIs
StatePublished - Sep 2007
Externally publishedYes

Fingerprint

Catheters
Ventriculoperitoneal Shunt
Infection
Morbidity
Reoperation
Neurosurgical Procedures
Peritoneal Cavity
Ambulatory Surgical Procedures
Patient Selection
Signs and Symptoms
Cerebrospinal Fluid
Survival Rate
Head
Economics
Costs and Cost Analysis
Recurrence
Skin

Keywords

  • Laparoscopy
  • Outcome
  • Shunt infection
  • Ventriculoperitoneal shunt

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Laparoscopic peritoneal catheter placement : Results of a new method in 111 patients. / Turner, Raymond D.; Rosenblatt, Steven M.; Chand, Bipan; Luciano, Mark.

In: Neurosurgery, Vol. 61, No. 3 SUPPL., 09.2007.

Research output: Contribution to journalArticle

Turner, Raymond D. ; Rosenblatt, Steven M. ; Chand, Bipan ; Luciano, Mark. / Laparoscopic peritoneal catheter placement : Results of a new method in 111 patients. In: Neurosurgery. 2007 ; Vol. 61, No. 3 SUPPL.
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abstract = "OBJECTIVE: Although cerebrospinal fluid shunting remains one of the most common neurosurgical procedures, it is fraught with high infection, blockage, and reoperation rates. It has been estimated that the economic cost of ventriculoperitoneal shunting exceeds $1 billion annually. A new laparoscopic technique that eliminates abdominal incisions overlying shunt hardware was applied to 111 patients requiring ventriculoperitoneal shunts in an effort to decrease the morbidity associated with shunting. METHODS: All patients who required ventriculoperitoneal shunt insertion were eligible for this surgical technique. Patient selection was based on availability of both surgical teams (general surgery and neurological surgery) at the time of surgery. Using this technique, the distal shunt catheter is tunneled directly from the head into the peritoneal cavity under laparoscopic guidance without a skin incision directly overlying the distal catheter insertion site. Patients were followed prospectively for signs and symptoms related to shunt dysfunction, shunt infection, and incision morbidity. RESULTS: One hundred eleven patients underwent 113 laparoscopic ventriculoperitoneal shunt surgeries between February 2003 and December 2004. The average follow-up period was 21.7 months (range, 12-34 mo). Nearly half of the patients (49{\%}) were discharged the next morning and the majority (81{\%}) was discharged within 2 days of surgery. Overall, 15 patients experienced complications requiring reoperation (13.5{\%}) with a 1-year shunt survival rate of 91{\%}. One patient (0.9{\%}) acquired a new shunt infection, whereas two patients (1.8{\%}) developed recurrence from a previous shunt infection. There were no abdominal incision-related complications. CONCLUSION: This simplified laparoscopic shunt placement technique, which requires no overlying abdominal incisions, can be performed quickly with high shunt survivability and low infection rates. Furthermore, the laparoscopic method has the advantage of fast recovery time, elimination of preperitoneal or misplaced catheters, and decreased abdominal incision morbidity. The procedure can be performed by either a multidisciplinary team or entirely by neurosurgeons.",
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