Comparison of catheter placement between laparoscopic and open surgery and the role of laparoscopic procedures and managements for common complications in peritoneal dialysis

Catheter survival is essential for successful peritoneal dialysis. Previous studies have proved that the success of peritoneal dialysis depends more on the catheter placement technique than on the catheter design. Therefore, the access used for catheter placement is the most important aspect of peritoneal dialysis. Currently, the principal accesses for catheter placements are as follows: (1) insertion with blind percutaneous puncture, (2) conventional open surgical placement with minimal dissection, (3) peritoneoscopy assisted implantation under limited visualization using a commercial Y-TEC package, and (4) laparoscopic catheter placement under direct wide-angle visualization with the possibility of sophisticated surgery conducted simultaneously. The well-known advantages of the recently advocated laparoscopic placement are the accuracy of the initial position under direct visualization and the possibility of performing other abdominal management concurrently. However, our team has achieved satisfactory results using modified conventional open placement of the peritoneal dialysis catheter for most patients who have undergone primary catheter placement. Both our prospective randomized study in comparing basic laparoscopic surgery with modified conventional catheter placement and 1 independent individual retrospective chart review in studying the usage of laparoscopic procedures in peritoneal dialysis show that laparoscopic procedure need not be routinely used for all primary catheter placements in patients with peritoneal dialysis. Furthermore, because of the shorter operative time and simpler equipment requirement of open surgery, this technique was found to be more cost effective and sufficiently conformed to most catheter implantation requirements. Therefore, modified conventional open surgery is first recommended for most patients who need primary catheter placement. Although laparoscopic surgery is more expensive and time consuming than open surgery, advanced laparoscopy employing more sophisticated procedures may be recommended for select patients simultaneously undergoing other abdominal treatments during catheter placement or as an effective means of managing several problems related to peritoneal dialysis, such as catheter salvage, catheter malfunction, pre-implantation evaluation, location of the source of the dialysate leak, and assessment of the causes of peritonitis. In addition, this chapter includes a literature review of the studies in comparing laparoscopic procedures with open catheter placement along with other management procedures for common complications related to peritoneal dialysis, including special Lunderquist guide-wire correction of catheter migration.