Mini-laparoscopy-assisted placement of Tenckhoff catheters: an improved technique to facilitate peritoneal dialysis

Abstract

Background and purpose: Despite its overall efficacy and patient satisfaction with it, peritoneal dialysis has a history of significant complications, which has contributed to the evolution in the technique from open laparotomy to minimally invasive placement of the catheters. Our goal was twofold: (1) to review our early experience with a technique of mini-laparoscopy-assisted (MLA) placement of dialysis catheters compared with open placement and (2) to demonstrate that urologists are able to provide a satisfactory procedure while concurrently developing and maintaining laparoscopic skills within a residency training program.

Patients and methods: The charts of the first 14 consecutive patients who underwent MLA placement of Tenckhoff dialysis catheters by a single surgeon (LCM) from January 1, 2000, through March 31, 2001, were reviewed. Postoperative narcotic analgesia, length of hospital stay, operative times, days until cycling, and rates of leakage, infection, and malfunction necessitating removal of catheters were compared with the corresponding data from 12 consecutive patients who underwent traditional open placement during the same time period. A telephone survey was performed to corroborate and supplement the findings from the chart review.

Results: Differences in complications necessitating catheter removal were not significant. The difference in the mean operative times of 41.7 minutes in the MLA group and 55.7 minutes for open placement was statistically significant. Postoperatively, the MLA group used less narcotic analgesia, had shorter hospital stays, and returned earlier to usual activities. The incidence of leakage after catheter placement was greater in the open group, although this difference was not statistically significant.

Conclusions: 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.