A laparoscopic approach to ventriculoperitoneal shunt placement in adults

Background: Ventriculoperitoneal shunts have been used for the treatment of hydrocephalus for years. In the past, the abdominal portion of this techni que has required mini-laparotomy. We present a series of 10 consecutive pat ients in which ventriculoperitoneal (VP) shunts were placed with laparoscop ic assistance. Materials and methods: At Lankenau Medical Center for July 1996 to January 1998, 10 patients (aged 22-81) with normopressure hydrocephalus underwent l aparoscopic VP shunt placement. The neurologic portion of the procedure is begun simultaneously with the abdominal procedure. After pneumoperitoneum i s established using a miniport disposable 2-mm introducer at the umbilicus, a 2-mm camera is introduced into the peritoneal cavity through the same po rt. A needle is introduced into the peritoneal cavity under direct visualiz ation. Once the catheter is placed ventricularly, it is tunneled subcutaneo usly to the abdomen. Using the Seldinger technique, the VP catheter is intr oduced under direct visualization through a sheath into the peritoneal cavi ty toward the pelvis. Positioning and function are also confirmed under dir ect visualization. Results: All patients tolerated this procedure well, and there were no comp lications. The benefits of this procedure include direct visualization of c atheter placement and smaller incisions than necessary for an open procedur e. Conclusion: We recommend laparoscopic-assisted placement of the VP shunt in normopressure hydrocephalus patients as a good alternative to the open tec hnique.