Skip to main content

Advertisement

SpringerLink
Log in

Laparoscopy-assisted ventriculoperitoneal shunt surgery: personal experience and review of the literature

  • Original Article
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

Ventriculoperitoneal shunting is a widely accepted technique for the treatment of hydrocephalus. The standard procedure to insert the peritoneal catheter requires an abdominal incision, muscle dissection, and opening of the peritoneum. A number of complications related to the abdominal surgical phase have been reported. Laparoscopy-assisted ventriculoperitoneal shunting is a valid alternative procedure that reduces surgical trauma. We describe our experience and review the literature. A total of 30 laparoscopically guided ventriculoperitoneal shunting procedures were performed between January 2007 and June 2008, in collaboration with a general surgeon experienced in laparoscopy. Of these procedures, 25 were new shunt placements and 5 were revisions. Data about operative time, outcome, and complications were registered and compared with a group of 30 patients treated by means of standard laparotomy in the period 2005–2007. Laparoscopic shunt placement was successful in all patients. Operative duration, complications, and postoperative pain were all lower in patients treated by laparoscopy as compared to the laparotomy. In the laparoscopic group, an earlier peristalsis, quicker mobilization, and better cosmetic results were also noted. Laparoscopy in both ventriculoperitoneal shunt placement and revision is a safe, effective, and minimally invasive technique. It ensures proper abdominal placement of the distal catheter under direct vision allowing confirmation of its patency.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Acharya R, Ramachandran CS, Singh S (2001) Laparoscopic management of abdominal complications in ventriculoperitoneal shunt surgery. J Laparoendosc Adv Surg Tech A 1(3):167–170

    Article  Google Scholar 

  2. Apuzzo MJ (1993) Cerebrospinal fluid diversion procedures. In: Apuzzo MJ (ed) Brain surgery: complication avoidance and management. Churchill Livingstone, New York, pp 1471–1474

    Google Scholar 

  3. Argo JL, Durgamani KY, Ballem N, Harrigan MR, Fisher WS III, Wesley MM, Taylor TH, Clemnts RH (2009) Laparoscopic versus open approach for implantation of the peritoneal catheter during ventriculoperitoneal shunt placement. Surg Endosc 23:1449–1455. doi:10.1007/s00464-008-0245-x

    Article  PubMed  Google Scholar 

  4. Armbruster C, Blauensteiner J, Ammerer HP, Kriwanek S (1993) Laparoscopically assisted implantation of ventriculoperitoneal shunts. J Laparoendosc Surg 3:191–192

    Article  PubMed  CAS  Google Scholar 

  5. Bani A, Hassler WE (2006) Laparoscopy-guided insertion of peritoneal catheters in ventriculoperitoneal shunt procedures: analysis of 39 children. Pediatr Neurosurg 42:156–158. doi:10.1159/000091858

    Article  PubMed  Google Scholar 

  6. Bani A, Telker D, Hassler W, Grundlach M (2006) Minimally invasive implantation of the peritoneal catheter in ventriculoperitoneal shunt placement for hydrocephalus: analysis of data in 151 consecutive adult patients. J Neurosurg 105:869–872

    Article  PubMed  Google Scholar 

  7. Cautico W, Vannix D (1995) Laparoscopically guided peritoneal insertion in ventriculoperitoneal shunts. J Laparoendosc Surg 5:309–311

    Article  Google Scholar 

  8. Esposito C, Colella G, Settimi A, Centonze A, Signorelli F, Ascione G, Palmieri A, Gangemi M (2003) One-trocar insufflation: a valid procedure to treat abdominal complications in children with peritoneal shunt for hydrocephalus. Surg Endosc 17(5):828–830. doi:10.1007/s00464-002-9063-8

    Article  PubMed  CAS  Google Scholar 

  9. Esposito C, Porreca A, Gangemi M, Garipoli V, De Pasquale M (1998) The use of laparoscopy in the diagnosis and treatment of abdominal complications of ventriculo-peritoneal shunts in children. Pediatr Surg Int 13(5–6):352–354

    Article  PubMed  CAS  Google Scholar 

  10. Goiten D, Papasvas P, Gagné D, Ferraro D, Wilder B, Caushaj P (2006) Single trocar laparoscopically assisted placement of central nervous system-peritoneal shunts. J Laparoendosc Adv Surg Tech A 16(1):1–4

    Article  Google Scholar 

  11. Greenberg MS (2006) Treatment of hydrocephalus. In: Greenberg MS (ed) Handbook of Neurosurgery, 6th edn. Thieme Medical Publishers, New York, pp 185–187

    Google Scholar 

  12. Handler MH, Callahan B (2008) Laparoscopic placement of distal ventriculoperitoneal shunt catheters. J Neurosurg Pediatr 2:282–285

    Article  PubMed  Google Scholar 

  13. Jea A, Al-Otibi M, Bonnard A, Drake JM (2007) Laparoscopy-assisted ventriculoperitoneal shunt surgery in children: a series of 11 cases. J Neurosurg 106(6):421–425

    PubMed  Google Scholar 

  14. Kavic SM, Segan RD, Taylor MD, Roth JS (2007) Laparoscopic management of ventriculoperitoneal and lumboperitoneal shunt complications. JSLS 11:14–19

    PubMed  Google Scholar 

  15. Khaitan L, Brennan EJ Jr (1999) A laparoscopic approach to ventriculoperitoneal shunt placement in adults. Surg Endosc 13(10):1007–1009

    Article  PubMed  CAS  Google Scholar 

  16. Khosrovi H, Kaufman HH, Hrabovsky E, Bloomfield SM, Prabhu V, el-Kadi HA (1998) Laparoscopic-assisted distal ventriculoperitoneal shunt placement. Surg Neurol 49(2):127–134

    Article  PubMed  CAS  Google Scholar 

  17. Kiefer M, Eymann R (2010) Gravitational shunt complications after a five-year follow-up. Acta Neurochir Suppl 106:107–112

    Article  PubMed  Google Scholar 

  18. Kirshtein B, Benifla M, Roy-Shapira A, Merkin V, Melamed I, Cohen Z, Cohen A (2004) Laparoscopically guided distal ventriculoperitoneal shunt placement. Surg Laparosc Endosc Percutan Tech 14(5):276–278

    Article  PubMed  CAS  Google Scholar 

  19. Kostantinidis H, Balogiannls I, Foroglu N, Spiliotopoulos A, Magras I, Keslsoglou I, Selviaridis P (2007) Laparoscopic placement of ventriculoperitoneal shunts: an innovative simplification of the existing techniques. Minim Invasive Neurosurg 50:62–64. doi:10.1055/s-2007-976513

    Article  Google Scholar 

  20. Kulkarni A, Drake J, Kestle J, Mallucci CL, Sgouros S, Constantini S (2010) Endoscopic third ventriculostomy vs cerebrospinal fluid shunt in the treatment of hydrocephalus in children: a propensity score-adjusted analysis. Neurosurgery 67(3):588–593

    Article  PubMed  Google Scholar 

  21. Li B, Zhang Q, Liu J, Hualong Yu, Sanyuan Hu (2007) Clinical application of a laparoscope in ventri-peritoneal shunting. Minim Invasive Ther Allied Technol 16(6):367–369. doi:10.1080/13645700701699547

    Article  PubMed  Google Scholar 

  22. Lifshutz Jason I, Walter J (2001) History of hydrocephalus and its treatments. Neurosurg Focus 11(2):1–5

    Article  Google Scholar 

  23. Lockhart C, Selman W, Rodziewiez G, Speltzer RF (1984) Percutaneous insertion of peritoneal shunt catheter with use of the Veress needle. J Neurosurg 60:444–446

    Article  PubMed  CAS  Google Scholar 

  24. Meier U, Kiefer M, Sprung C (2004) Evaluation of the Miethke dual-switch valve in patients with normal pressure hydrocephalus. Surg Neurol 61:119–127

    Article  PubMed  Google Scholar 

  25. Meier U, Lemcke J, Al-Zain F (2008) Course of disease in patients with idiopathic normal pressure hydrocephalus (iNPH): a follow-up study 3, 4 and 5 years following shunt implantation. Acta Neurochir Suppl 102:125–127

    Article  PubMed  CAS  Google Scholar 

  26. Nfonsam V, Chand B, Rosenblatt S (2008) Laparoscopic management of distal ventriculoperitoneal shunt complications. Surg Endosc 22:1860–1870. doi:10.1007/s00464-007-9728-4

    Article  Google Scholar 

  27. Nuzzo G, Giuliante F, Tebala GD, Vellone M, Cavicchioni C (1997) Routine use of laparoscopic operations. J Am Coll Surg 184(1):58–62

    PubMed  CAS  Google Scholar 

  28. Ochalski PG, Horowitz MB, Mintz AH, Hughes SJ, Okonkwo DO, Kassam AB, Watson AR (2009) Minimal-access technique for distal catheter insertion during ventricular peritoneal shunt procedures: a review of 100 cases. J Neurosurg 13:1–5. doi:10.3171/2009.2.JNS08454

    Google Scholar 

  29. Patwardhan RV, Nanda A (2005) Implanted ventricular shunts in the United States: the billion-dollar-a-year cost of hydrocephalus treatment. Neurosurgery 56:139–144. doi:10.1227/01.NEU.0000146206.40375.41

    PubMed  Google Scholar 

  30. Reimer R, Wharen RE, Jr PPDM (1998) Ventriculoperitoneal shunt placement with video-laparoscopic guidance. J Am Coll Surg 187:637–639

    Article  PubMed  CAS  Google Scholar 

  31. Rolle U, Gräfe G, brock D, Grosser K (1998) Laparoscopy-assisted abdominal shunt revisions in children with hydrocephalus. Eur J Pediatr Surg 8(1):60

    PubMed  Google Scholar 

  32. Roth JS, Park E, Gewirtz R (2000) Minilaparoscopically assisted placement of ventriculoperitoneal shunts. Surg Endosc 14:461–463. doi:10.1007/s004640020017

    Article  PubMed  CAS  Google Scholar 

  33. Roth J, Sagie B, Szold A, Elran H (2007) Laparoscopic versus non-laparoscopic-assisted ventriculoperitoneal shunt placement in adults. A retrospective analysis. Surg Neurol 68(2):177–184. doi:10.1016/j.surneu.2006.10.069

    Article  PubMed  Google Scholar 

  34. Schievink WI, Wharen RE, Jr RR, Pettit PDM, Seiler JC, Shine TSJ (1993) Laparoscopic placement of ventriculoperitoneal shunts: preliminary report. Mayo Clin Proc 68:1064–1066

    PubMed  CAS  Google Scholar 

  35. Schubert F, Fijen BP, Krauss JK (2005) Laparoscopically assisted peritoneal shunt insertion in hydrocephalus: a prospective controlled study. Surg Endosc 19(12):1588–1591. doi:10.1007/s00464-005-0164-z

    Article  PubMed  CAS  Google Scholar 

  36. Schukfeh N, Tschan CA, Kuebler JF, Hermann EJ, Nustede R, Krauss JK, Ure B, Gluer S (2009) Laparoscopically assisted ventriculoperitoneal shunt placement in infants with previous multiple abdominal operations. Eur J Pediatr Surg 19:168–170

    Article  PubMed  CAS  Google Scholar 

  37. Sekula RF, Marchan EM, Oh MY, kim DK, Frederickson AM, Pelz G, Uchal M (2009) Laparoscopically assisted peritoneal shunt insertion for hydrocephalus. Br J Neurosurg 23(4):439–442. doi:10.1080/02688690902755605

    Article  PubMed  Google Scholar 

  38. Tepetes K, Tzovaras G, Paterakis K, Spyridakis M, Xautouras N, Hatzitheofilou C (2006) Inoe trocar laparoscopic placement of peritoneal shunt for hydrocephalus: a simplified technique. Clin Neurol Neurosurg 108(6):580–582

    Article  PubMed  Google Scholar 

  39. Turner RD, Rosenblatt SM, Chand B, Luciano MG (2007) Laparoscopic peritoneal catheter placement: results of a new method in 111 patients. Neurosurgery 61:167–172, discussion 172–174

    Article  PubMed  Google Scholar 

  40. Yu S, Bensard DD, Partrick DA et al (2006) Laparoscopic guidance or revision of ventriculoperitoneal shunts in children. JSLS 10:122–125

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Health Sciences (Neurosurgery), University of L’Aquila, Piazza S. Tommasi 1, 67100, L’Aquila, Italy

    Soheila Raysi Dehcordi & Renato J. Galzio

  2. Department of Surgical Sciences (General Surgery), University of L’Aquila, Piazza S. Tommasi 1, 67100, L’Aquila, Italy

    Cristina Ruscitti & Gianfranco Amicucci

  3. Operative Unit of Neurosurgery, San Salvatore Hospital, via Vetoio, Coppito, 67100, L’Aquila, Italy

    Claudio De Tommasi, Alessandro Ricci, Sara Marzi & Renato J. Galzio

Authors
  1. Soheila Raysi Dehcordi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Claudio De Tommasi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alessandro Ricci
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sara Marzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Cristina Ruscitti
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gianfranco Amicucci
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Renato J. Galzio
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Soheila Raysi Dehcordi.

Additional information

Comments

Hartmut Collmann, Würzburg, Germany

In this paper dealing with shunt surgery in adults, the authors focus on the risks associated with the insertion of the peritoneal catheter, namely malpositioning and bowel perforation. In a mainly retrospective study on two cohorts of 30 patients, respectively, the authors compare the conventional technique of distal catheter insertion via a small laparatomy with a laparascopically guided trocar technique. With the conventional technique, they report one case of bowel injury and five additional cases of malpositioned catheters, while these complications did not occur in the laparascopically treated group. The authors conclude that laparascopic control significantly improves the safety of distal catheter placement. For now, they do not advocate the laparascopic technique as a routine, mainly for logistic reasons, i.e., the need of a separate surgical team.

The authors are certainly right, when they consider distal catheter placement a less than trivial procedure in some cases, particularly in elderly patients with slack, obese abdominal walls or with a history of complicated abdominal surgery. Nevertheless, their complication rate is unusually high and contrasts with several reports based on larger cohorts, some of which are cited in the text, while others are not (2, 3, 4). In fact, malposition of the distal catheter and bowel perforation are generally not considered a major problem of shunt surgery in elderly people (1).

Looking at the results in more detail, one is wondering why:

–In three out of 30 cases, the surgeons were not able to verify proper access to the peritoneal cavity during conventional laparatomy,

–Mere coiling of a distal catheter should result in shunt malfunction, and

–Peritoneal adhesions per se should lead to shunt malfunction after weeks or months, unless they cause a pseudocyst or localized ascites.

It is beyond question that the laparascopically guided trocar technique causes less postoperative pain. But, the same goal can be achieved by using the blind trocar technique as customary in many centers.

Finally, although in this study the laparascopic technique did not increase the rate of shunt infection, this result still needs validation since minimal handling of the shunt hardware is a classical imperative not yet disproved. Nevertheless, laparascopy should be considered a useful surgical aid in selected patients, e.g., with a history of major or complicated abdominal surgery. The authors provide valuable advice for practicing this technique in shunt surgery.

References

1. Bergsneider M, Black PM, Klinge P et al. (2005) Surgical management of idiopathic normal-pressure hydrocephalus. Neurosurgery 57 (Suppl 3):S29-S39

2. Boon AJ, Tans JD, Delwel EJ et al (1998) Dutch normal-pressure hydrocephalus study: randomized comparison of low- and medium-pressure shunts. J Neurosurg 88:490-495

3. Vanneste J, Augustijn P, Dirven C, Tan WF, Goedhart ZD (1992) Shunting normal pressure-hydrocephalus: do the benefits outweigh the risks? Neurology 42:54-59

4. Zemack G, Romner B (2002) Adjustable valves in normal-pressure hydrocephalus: a retrospective study of 218 patients. Neurosurgery 51:1392-1402

Sherif Elwatidy, Riyadh, Saudi Arabia

The authors presented their experience with laparoscopy-assisted VP shunt, which has the advantage of being a minimally invasive technique for placement of the peritoneal catheter and ensures proper placement of the catheter into the peritoneal cavity. There has been always difficulty in placing the distal catheter in patients with abdominal adhesions due to previous infections, laparoscopy-assisted technique solves this problem and facilitates the operation. However, the procedure requires experience with laparoscopic surgery or the presence of a general surgeon with experience in laparoscopic surgery, which will necessitate special arrangements particularly in emergency situation. Therefore, laparoscopy-assisted VP shunt would be highly recommended for complicated and redo cases.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Raysi Dehcordi, S., De Tommasi, C., Ricci, A. et al. Laparoscopy-assisted ventriculoperitoneal shunt surgery: personal experience and review of the literature. Neurosurg Rev 34, 363–371 (2011). https://doi.org/10.1007/s10143-011-0309-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10143-011-0309-6

Keywords

Search

Navigation