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. 2023 May 16;59(5):961.
doi: 10.3390/medicina59050961.

Peritoneal Dialysis Catheter Placement in Children: Initial Experience with a "2+1"-Port Laparoscopic-Assisted Technique

Vlad-Laurentiu David  1 , Elisa Mussuto  2 , Ramona-Florina Stroescu  3 , Mihai Gafencu  3 , Eugen-Sorin Boia  1
Affiliations

Peritoneal Dialysis Catheter Placement in Children: Initial Experience with a "2+1"-Port Laparoscopic-Assisted Technique

Vlad-Laurentiu David et al. Medicina (Kaunas). .

Abstract

The placement of a peritoneal dialysis catheter (PDC) is currently a common procedure in pediatric surgeon practice, and the search for the ultimate technique never stops. The purpose of this study is to evaluate our experience with the laparoscopic PDC placement approach, performing a "2+1" ("two plus one") technique, where the "+1" trocar is placed in an oblique manner, pointing toward the Douglas pouch when passing through the abdominal wall. This tunnel is further used to place and maintain the proper position of the PDC.

Materials and methods: We assessed a cohort of five children who underwent laparoscopic-assisted PDC placement between 2018 and 2022.

Results: This procedure is a simple, relatively quick, and safe technique for PDC placement. Furthermore, in our experience, concomitant omentectomy is necessary to reduce the risk of catheter obstruction and migration due to omental wrapping.

Conclusions: The laparoscopic approach allows for improved visualization and more accurate placement of a catheter inside the abdominal cavity. Concomitant omental excision is necessary to prevent PDC malfunction and migration.

Keywords: catheter; child; laparoscopy; omentectomy; pediatric; peritoneal dialysis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Marking the desired position of the catheter and the entry point.
Figure 2
Figure 2
Position of the ports and insertion of the third trocar. The third port was inserted in an oblique orientation, passes through the abdominal wall, and enters the peritoneal cavity, following the external drawings and guided by the light source.
Figure 3
Figure 3
The tip of the catheter was grasped and pulled down to the Douglas pouch, taking care to place the distal cuff in the proper position (red arrow).
Figure 4
Figure 4
The proximal cuff was placed in the subcutaneous tissue and the catheter was secured to the skin.
Figure 5
Figure 5
The final aspect.
Figure 6
Figure 6
Peritoneal dialysis catheter wrapped by omentum and blocked in patient 3.
See this image and copyright information in PMC

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