Single trocar laparoscopically assisted placement of central nervous system-peritoneal shunts.
BACKGROUND
Lumbar peritoneal and ventriculoperitoneal shunts are widely used for the treatment of hydrocephalus. In the past, the abdominal portion of these procedures required laparotomy. With the advent of minimally invasive techniques, laparoscopically assisted placement of the distal catheter has been tried.


METHODS
We performed 10 shunt procedures (3 lumbar peritoneal, 6 ventriculoperitoneal, and 1 meningomyelocele-peritoneal) in 10 patients (mean age 56; age range, 30-78 years). Four patients had undergone previous open shunt placement that failed. The abdominal portion of the procedure was performed using a 5-mm trocar and a 10Fr introducer for camera and catheter insertion. In 3 cases, an additional 5-mm port was necessary for lysis of adhesions. These access punctures did not require fascial closure and caused minimal pain and limitation.


RESULTS
No intra- or postoperative complications were encountered in this small patient group. At a median follow-up of 50 months (range, 3-56 months) all patients had functioning shunts.


CONCLUSIONS
Single trocar laparoscopically assisted placement of central nervous system-peritoneal shunts is safe and simple, and should be considered the procedure of choice. This technique is also suitable for repositioning migrated catheters and other catheter-tip manipulations.
Department of Surgery, Temple University Clinical Campus at The Western Pennsylvania Hospital, 4800 Friendship Avenue, Pittsburgh, PA 15224, USA.
David
D
Goitein
Pavlos
P
Papasavas
Daniel
D
Gagné
David
D
Ferraro
Bruce
B
Wilder
Philip
P
Caushaj
D000328:Adult; D000368:Aged; D002557:Cerebrospinal Fluid Shunts / Q000379:methods*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D020706:Laparoscopes; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D017287:Ventriculoperitoneal Shunt / Q000379:methods