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Flexible endoscopic single-incision extraperitoneal implant and fixation of peritoneal dialysis catheter: proof of concept in the porcine model

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Abstract

Background

Peritoneal dialysis (PD) catheters placed in the pelvic space without anchoring present a high rate of migration. We aimed to assess the feasibility of a single-incision approach, using a flexible endoscopic preperitoneal tunneling for catheter implantation and fixation.

Materials and methods

Eight pigs were involved in this experimental study. A 2/0 Vicryl loop was sutured at the tip of a PD catheter. In 4 pigs, a 1.5 cm incision was made on the left paramedian line and the parietal peritoneal layer was identified by splitting rectal muscles. A gastroscope was inserted in the incision and advanced in the extraperitoneal space. An exit hole was made in the peritoneum over the low pelvic cavity. A guidewire was left in the abdominal cavity, and the PD catheter was inserted over the guidewire. The endoscope was inserted in the tunnel again, and endoscopic clips were deployed over the Vicryl loop to fix the catheter. In 4 pigs, the PD catheter was inserted laparoscopically using a two-port approach. The catheter’s tip was fixed with laparoscopic clips on the Vicryl loop. A strain test to assess the force required to detach clips was performed using a digital dynamometer.

Results

Operative time for flexible endoscopic tunneling was longer when compared to the laparoscopic implant (29.5 ± 4.43 vs. 22.7 ± 2.51 min). Mean force to displace the catheter was similar after flexible endoscopic fixation when compared to laparoscopic clip fixation (5.57 N ± 2.76 vs. 4.15 N ± 1.76).

Conclusions

Flexible endoscopic extraperitoneal tunneling allows for minimally invasive single-incision PD catheter placement and fixation.

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References

  1. Mutter D, Callari C, Diana M, Bencheikh L, Heibel F, Marescaux J (2011) A novel technique to treat hydrothorax in peritoneal dialysis: laparoscopic hepato-diaphragmatic adhesion. Perit Dial Int 31:692–694

    Article  PubMed  Google Scholar 

  2. Crabtree JH (2008) Fluoroscopic placement of peritoneal dialysis catheters: a harvest of the low-hanging fruits. Perit Dial Int 28:134–137

    PubMed  Google Scholar 

  3. Borazan A, Comert M, Ucan BH et al (2006) The comparison in terms of early complications of a new technique and percutaneous method for the placement of CAPD catheters. Ren Fail 28:37–42

    Article  PubMed  Google Scholar 

  4. Li PK, Szeto CC, Piraino B et al (2010) Peritoneal dialysis-related infections recommendations: 2010 update. Perit Dial Int 30:393–423

    Article  PubMed  Google Scholar 

  5. McCormick BB, Bargman JM (2007) Noninfectious complications of peritoneal dialysis: implications for patient and technique survival. J Am Soc Nephrol 18:3023–3025

    Article  PubMed  Google Scholar 

  6. Wright MJ, Bel’eed K, Johnson BF, Eadington DW, Sellars L, Farr MJ (1999) Randomized prospective comparison of laparoscopic and open peritoneal dialysis catheter insertion. Perit Dial Int 19:372–375

    CAS  PubMed  Google Scholar 

  7. Tsimoyiannis EC, Siakas P, Glantzounis G et al (2000) Laparoscopic placement of the Tenckhoff catheter for peritoneal dialysis. Surg Laparosc Endosc Percutan Tech 10:218–221

    CAS  PubMed  Google Scholar 

  8. Lu CT, Watson DI, Elias TJ, Faull RJ, Clarkson AR, Bannister KM (2003) Laparoscopic placement of peritoneal dialysis catheters: 7 years experience. ANZ J Surg 73:109–111

    Article  PubMed  Google Scholar 

  9. Ogunc G, Tuncer M, Ogunc D, Yardimsever M, Ersoy F (2003) Laparoscopic omental fixation technique versus open surgical placement of peritoneal dialysis catheters. Surg Endosc 17:1749–1755

    Article  CAS  PubMed  Google Scholar 

  10. Agulnik M, Hirsch DJ (2001) Resource utilization for peritoneal catheter placement. ASAIO J 47:97–98

  11. Crabtree JH, Kaiser KE, Huen IT, Fishman A (2001) Cost-effectiveness of peritoneal dialysis catheter implantation by laparoscopy versus by open dissection. Adv Perit Dial 17:88–92

    CAS  PubMed  Google Scholar 

  12. Yang P-J, Lee C-Y, Yeh C-C, Nien H-C, Tsai T-J, Tsai M-K (2010) Mini-laparotomy implantation of peritoneal dialysis catheters: outcome and rescue. Perit Dial Int 30:513–518

    Article  PubMed  Google Scholar 

  13. Crabtree JH, Fishman A (2005) A laparoscopic method for optimal peritoneal dialysis access. Am Surg 71:135–143

    PubMed  Google Scholar 

  14. Batey CA, Crane JJ, Jenkins MA, Johnston TD, Munch LC (2002) Mini-laparoscopy-assisted placement of Tenckhoff catheters: an improved technique to facilitate peritoneal dialysis. J Endourol 16:681–684

    Article  PubMed  Google Scholar 

  15. Soontrapornchai P, Simapatanapong T (2004) Comparison of open and laparoscopic secure placement of peritoneal dialysis catheters. Surg Endosc 19:137–139

    Article  PubMed  Google Scholar 

  16. Comert M, Borazan A, Kulah E, Uçan BH (2004) A new laparoscopic technique for the placement of a permanent peritoneal dialysis catheter: the preperitoneal tunneling method. Surg Endosc 19:245–248

    Article  PubMed  Google Scholar 

  17. Yun EJ, Meng MV, Brennan TV, McAninch JW, Santucci RA, Rogers SJ (2003) Novel microlaparoscopic technique for peritoneal dialysis catheter placement. Urology 61:1026–1028

    Article  PubMed  Google Scholar 

  18. Flanigan M, Gokal R (2005) Peritoneal catheters and exit-site practices toward optimum peritoneal access: a review of current developments. Perit Dial Int 25:132–139

    PubMed  Google Scholar 

  19. Bar-Zohar D, Sagie B, Lubezky N, Blum M, Klausner J, Abu-Abeid S (2006) Laparoscopic implantation of the Tenckhoff catheter for the treatment of end-stage renal failure and congestive heart failure: experience with the pelvic fixation technique. Isr Med Assoc J 8:174–178

    PubMed  Google Scholar 

  20. Li J-R, Chen C-H, Cheng C-L et al (2012) Five-year experience of peritoneal dialysis catheter placement. J Chin Med Assoc 75:309–313

    Article  PubMed  Google Scholar 

  21. Beck DE, Opelka FG, Bailey HR, Rauh SM, Pashos CL (1999) Incidence of small-bowel obstruction and adhesiolysis after open colorectal and general surgery. Dis Colon Rectum 42:241–248

    Article  CAS  PubMed  Google Scholar 

  22. Duepree H-J, Senagore AJ, Delaney CP, Fazio VW (2003) Does means of access affect the incidence of small bowel obstruction and ventral hernia after bowel resection? Laparoscopy versus laparotomy. J Am Coll Surg 197:177–181

    Article  PubMed  Google Scholar 

  23. Leroy J, Diana M, Callari C et al (2012) Laparoscopic extraperitoneal colostomy in elective abdominoperineal resection for cancer: a single surgeon experience. Colorectal Dis 14:e618–e622

    Article  CAS  PubMed  Google Scholar 

  24. Blessing WD Jr, Ross JM, Kennedy CI, Richardson WS (2005) Laparoscopic-assisted peritoneal dialysis catheter placement, an improvement on the single trocar technique. Am Surg 71:1042–1046

    PubMed  Google Scholar 

  25. Milliken I, Fitzpatrick M, Subramaniam R (2006) Single-port laparoscopic insertion of peritoneal dialysis catheters in children. J Pediat Urol 2:308–311

    Article  CAS  Google Scholar 

  26. Dhumane PW, Diana M, Leroy J, Marescaux J (2011) Minimally invasive single-site surgery for the digestive system: a technological review. J Minim Access Surg 7:40–51

    PubMed Central  PubMed  Google Scholar 

  27. Diana M, Dhumane P, Cahill RA, Mortensen N, Leroy J, Marescaux J (2011) Minimal invasive single-site surgery in colorectal procedures: current state of the art. J Minim Access Surg 7:52–60

    PubMed Central  PubMed  Google Scholar 

  28. Leroy J, Diana M, Wall J, Costantino F, D’Agostino J, Marescaux J (2011) Laparo-endoscopic single-site (LESS) with transanal natural orifice specimen extraction (NOSE) sigmoidectomy: a new step before pure colorectal natural orifices transluminal endoscopic surgery (NOTES(R)). J Gastrointest Surg 15:1488–1492

    Article  PubMed  Google Scholar 

  29. Yeh CN, Liao CH, Liu YY et al (2013) Dual-incision laparoscopic surgery for peritoneal dialysis catheter implantation and fixation: a novel, simple, and safe procedure. J Laparoendosc Adv Surg Tech Part A 23:673–678

    Article  Google Scholar 

  30. Ogunc G (2005) Minilaparoscopic extraperitoneal tunneling with omentopexy: a new technique for CAPD catheter placement. Perit Dial Int 25:551–555

    PubMed  Google Scholar 

Download references

Acknowledgments

Authors are grateful to Guy Temporal, Lucie Oudot, and Christopher Burel for their assistance in proofreading the manuscript.

Disclosures

Jacques Marescaux is the President of both IRCAD and IHU Institutes, which are partly funded by Karl Storz Endoskope, Covidien, and Siemens Healthcare. Remaining authors have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. IRCAD, Digestive and Endocrine Surgery, University of Strasbourg, 1, place de l’Hôpital, 67091, Strasbourg Cedex, France

    Yu-Yin Liu, Michele Diana, Bernard Dallemagne & Jacques Marescaux

  2. IHU-Strasbourg, Image-Guided Minimally Invasive Surgical Institute, University of Strasbourg, 1, place de l’Hôpital, 67091, Strasbourg Cedex, France

    Michele Diana, Peter Halvax, Sungwoo Cho, András Légner, Amilcar Alzaga, Lee Swanström, Bernard Dallemagne & Jacques Marescaux

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  1. Yu-Yin Liu
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  2. Michele Diana
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  3. Peter Halvax
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  4. Sungwoo Cho
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  7. Lee Swanström
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  8. Bernard Dallemagne
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  9. Jacques Marescaux
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Corresponding author

Correspondence to Michele Diana.

Additional information

Yu-Yin Liu and Michele Diana are Equal contribution to this work.

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Liu, YY., Diana, M., Halvax, P. et al. Flexible endoscopic single-incision extraperitoneal implant and fixation of peritoneal dialysis catheter: proof of concept in the porcine model. Surg Endosc 29, 2402–2406 (2015). https://doi.org/10.1007/s00464-014-3951-6

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  • DOI: https://doi.org/10.1007/s00464-014-3951-6

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