A laparoscopic approach under local anesthesia for peritoneal dialysis access.

OBJECTIVE

Presented herein is a technical description of a time-proven laparoscopic approach to establishing successful long-term peritoneal dialysis access.

DESIGN

Using a two-port technique, the peritoneal catheter is inserted through a paramedian port site while continuously monitoring the implant procedure with a laparoscope from a second port location. A long rectus sheath tunnel created with a nontrocar port device keeps the dialysis catheter oriented toward the pelvis. Helium abdominal insufflation enables full surgical laparoscopy under local anesthesia. Validation of the effectiveness of the technique is made by comparison to previous implantation experience using an open dissection method.

PATIENTS

Laparoscopic implantation of peritoneal catheters was performed in 150 patients, and placement by open dissection was accomplished in 63 patients.

MAIN OUTCOME MEASURE

The incidence of complications and revision-free catheter survival between implantation methods were compared.

RESULTS

Catheters implanted laparoscopically had a significantly lower incidence of flow dysfunction (p < 0.05) and better survival (p < 0.001) than those placed by open dissection.

CONCLUSIONS

Compared to implantation by open dissection, the laparoscopic approach provides the patient reduced perioperative discomfort. The procedure can be performed safely with the patient under local anesthesia on an ambulatory basis. Laparoscopic implantation significantly reduces the incidence of catheter flow dysfunction and permits simultaneous identification and correction of other problems that could complicate dialysis therapy.