Laparoscopic Placement of PD Catheter

Laparoscopic Access Procedures


		Laparoscopic Placement of PD Catheter

Laparoscopic Placement of Peritoneal Dialysis Catheter

As peritoneal dialysis became more and more popular, a simple laparoscopic technique was developed to place the PD catheter in proper intra-abdominal position. In addition, it is now being reported that laparoscopy may become the surgical method of choice to investigate and reposition malfunctioning PD catheters.

Indications

All patients are candidates for Peritoneal dialysis. Previous laparotomies can impair such placement.

Operating Room Set-up

Instruments or OR Set-up

LAPAROSCOPIC HARDWARE
Telescope	Stryker 5 mm - 30 Deg.
Insufflator	High Flow
Video out	NA
Suction Irrigation	No

ESSENTIAL LAPAROSCOPIC INSTRUMENTS
QQTY	Instrument	Website
1	Coiled PD Catheter
3	USSC Versaport V2 Trocar 5 mm - 179094
1	Storz Dolphin Nose 5 mm Grasper
1	USSC SURGINEEDLE

The Technique

Step 1

Choosing the Entry Site of the PD Catheter

The surgeon should carefully chose the entry site of the PD catheter in/on the abdominal wall to deploy it in the pelvis from this position. The location is marked.

The pneumoperitoneum is created.

Step 2

Inserting the trocars

The trocars are inserted. An upper 5 mm trocar is inserted midline in the upper portion of the abdomen. The lower 5 mm trocar is inserted 3 cm above the mark previously made on the abdomen. The 5mm is angled and tunneled for 3 cm under the anterior abdominal wall. Its entry site into the abdomen should be right under the skin mark.

Peritoneal Dialysis Catheter

Step 3

Placing the PD Catheter

A Dolphin Nose Grasper is inserted via the upper 5 mm trocar into the intra-abdominal cavity. It enters the lower 5 mm trocar and exits the intra-abdominal cavity through the trocar. The lower trocar is removed over the grasper. The coiled tip of the PD catheter is grasped and pulled into the intra-abdominal cavity. It is then placed into the pelvis in optimal position.

The catheter is anchored to the skin with a silk suture and tested after the position of the Dacron cuffs is checked. The abdomen is deflated and the trocars removed.

The PD catheter can be used in seven days.

Video

Laparoscopic Placement PD Catheter -73891