Use of a New Type of Trocar for the Surgical Treatment of Hydrocephalus: A Simple and Effective Technique

Abstract

This study compared the use of a new type of peritoneocentesis trocar with conventional laparotomy for the placement of the distal catheter in the treatment of hydrocephalus with ventriculoperitoneal shunt. A total of 376 patients with hydrocephalus were recruited to the study and were assigned randomly to undergo insertion of the distal catheter by conventional laparotomy (n = 195) or using the new peritoneal trocar (n = 181). The time taken for the surgical procedure and the complication rate over the following 1-year period were compared between the two groups. The mean length of the procedure to place the distal catheter was significantly shorter in the trocar group compared with the laparotomy group. Infection and obstruction rates were significantly higher in the laparotomy group than in the trocar group. In conclusion, the use of the new trocar was associated with lower rates of surgically induced trauma and complications compared with conventional laparotomy.

Novel type of peritoneocentesis trocar-assisted distal ventriculoperitoneal shunt placement with supervision via a one-port laparoscope

“…Therefore, shunt placement techniques have become a focus of extensive research ( 9 ). However, disadvantages of the existing techniques remain and lead to difficult surgeries with extensive trauma.…”

“…As in a previous study ( 9 ), the peritoneal trocar was composed of different parts, including the sheath and core needle, made of steel. The trocar was ~13 cm long with an outer sheath diameter of 0.5 cm and an inner needle diameter of ~0.3 cm.…”

Laparoscopic Assisted Treatment of Hydrocephalus in Adults: Our Own Modification

“…Stone et al [5] in a 15-year retrospective study concluded that 84.5% of patients required one or more shunt revisions. Naftel et al [19] observed rates of shunt failure of up to 20.9%. Kestle et al [36] reported that distal mechanical failure comprises 25-30% of all malfunctions.…”

“…A peel-away introducer sheath has also been used to insert the catheter through the abdominal wall [18]. Use of a single trocar technique has also been described with equal success [4,[19][20][21]. The method we describe is using a single trocar, however the insertion location is different.…”

“…The reduction in operative time can be attributed to the simultaneous operation of the abdomen by additional general surgeons using a laparoscopic method whilst the neurosurgeon accesses the ventricle [37]. Wang et al [19] reported an average operative duration using a laparoscopic technique of 48 minutes (range 22-53 minutes). The reduction in operative time was potentially due to the use of a single trocar laparoscopic technique.…”