A laparoscopic approach under local anesthesia for peritoneal dialysis access

Objective: Presented herein is a technical description of a time-proven lap aroscopic approach to establishing successful long-term peritoneal dialysis access. Design: Using a two-port technique, the peritoneal catheter is inserted thr ough a paramedian port site while continuously monitoring the implant proce dure with a laparoscope from a second port location. A long rectus sheath t unnel created with a nontrocar port device keeps the dialysis catheter orie nted 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 i n 150 patients, and placement by open dissection was accomplished in 63 pat ients. Main Outcome Measure: The incidence of complications and revision-free cath eter survival between implantation methods were compared. Results: Catheters implanted laparoscopically had a significantly lower inc idence 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 procedu re can be performed safely with the patient under local anesthesia on an am bulatory basis. Laparoscopic implantation significantly reduces the inciden ce of catheter flow dysfunction and permits simultaneous identification and correction of other problems that could complicate dialysis therapy.