Mini-Laparoscopy-Assisted Placement of Tenckhoff Catheters: An Improved Technique to Facilitate Peritoneal Dialysis

Abstract

The MLA technique of dialysis catheter placement appears to have similar or greater efficacy than the open technique. It is a viable teaching procedure, and with reusable 3-mm ports and shorter operative times, it is cost efficient as well.

Prospective Randomized Study for Comparison of Open Surgery with Laparoscopic-Assisted Placement of Tenckhoff Peritoneal Dialysis Catheter—A Single Center Experience and Literature Review

“…Unlike most previous studies [22,25,27,28] with the exception of that by Wright et al [23], in this study, postoperative pain and the requirement of analgesics did not differ between the laparoscopic and open groups. A likely explanation is that the pain caused by a limited dissection via mini wound in the open group was equivalent to the mild pain produced by carbon dioxide pneumoperitoneum during the laparoscopic procedure [31].…”

“…Early and late complications did not statistically differ in the present study. Similar results were also shown in previous comparative studies [22,23,25], although others have reported reduced outflow obstruction when using laparoscopy [26][27][28][29]. One portsite bleeding was noticed by Draganic et al in thirty laparoscopic placements [22].…”

“…Such reports have indicated laparoscopic surgery has a lower failed-insertion rate (0% to 2.4%), a lower short-term complication rate (0% to 9.5%), and a higher long-term catheter survival rate (63% to 85%) than that of open surgery. However, other studies have reported otherwise [22][23][24][25]. Comparative studies in English medical literature lack consensus [22][23][24][25][26][27][28][29].…”

“…However, other studies have reported otherwise [22][23][24][25]. Comparative studies in English medical literature lack consensus [22][23][24][25][26][27][28][29]. The ideal method for inserting PD catheter remains debatable.…”

Guidelines for laparoscopic peritoneal dialysis access surgery

“…Omentopexy requires a suture passing needle such as Endoclose TM (Covidian, Norwalk, CT), Carter-Thompson device or laparoscopic suturing equipment and nonabsorbable suture. Mini-laparoscopic instruments have also been used with equal success [95,127,[141][142][143]. Despite the paucity of publications comparing leak rates and the size of trocars, most authors recommend the smallest ports available in a non-cutting variety to allow the quickest healing of the peritoneum, thus facilitating early start of PD and low leak rate.…”