How can videolaparoscopy be used in a peritoneal dialysis programme?

Background. Recently videolaparoscopy is considered to have a vaster use in surgery due to the undeniable benefits such as low operatory traumatism, q uick recovery of canalization, a short stay in the hospital and minor scarr ing. Methods. Forty patients were treated with peritoneal dialysis (PD); 15 vide olaparoscopic procedures were performed on 13 patients before starting PD a nd two during the course of PD. The videolaparoscopy procedure was started by inducing pneumoperitoneum after initiation of general anaesthesia throug h endotracheal intubation. Results. Peritoneal catheter placement was carried out in 11 ESRD patients showing abdominal scars due to previous laparotomies; their abdominal condi tion precluded safe PC placement using conventional non-laparoscopic proced ures with local anaesthesia. Release of adhesions was performed only in two patients. Videolaparoscopy was also used in three patients for elective ch olecystectomy; 2/3 underwent concomitant PC insertion. One patient was subm itted to cholecystectomy during the course of CAPD; following the procedure we left the peritoneum dry overnight and then we started temporary IPD, us ing small volumes, avoiding haemodialysis (HD). Regular CAPD was resumed 6 days later. Finally, videolaparoscopy was also used for diagnostic purpose i.e. in one 59-year-old man patient who had a peritoneal catheter obstructi on. Repeated rescue attempts using urokinase solution to irrigate the perit oneal catheter had been used in vain attempts prior to the procedure. Conclusions. Videolaparoscopy proves to be a useful tool in a PD programme. Firstly, it may be used as a technique for catheter implantation, not as a routine procedure but in patients with extensive abdominal scars due to pr evious laparotomy, i.e. at risk for accidental viscera perforation due to t he possibility of adhesions between intestinal loops and parietal peritoneu m. Secondly, videolaparoscopy used for abdominal surgery allows the resumpt ion of PD immediately after surgical procedure and thus avoiding HD. Videol aparoscopy is fundamental for diagnosis and rescue of catheter dysfunction and has an integral role in the successful management of these patients in extending catheter function and permitting safe replacement of peritoneal c atheter if it becomes necessary. Along with the undeniable advantages, rema ins the disadvantages that it must be carried out by an expert surgeon in a n operating theatre while the patient is under general anaesthesia.