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Laparoscopic Access Procedures

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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.

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Indications

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

bulletOperating Room Set-up

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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  

 

 

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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.

 

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