Laparoscopic peritoneal dialysis catheter implantation using a Tenckhoff trocar under local anesthesia with nitrous oxide gas insufflation.
BACKGROUND
Laparoscopic implantation of peritoneal dialysis catheters has many advantages over conventional methods. The ability to perform laparoscopy with the patient under local anesthesia allows renal failure patients, who ordinarily might not be considered candidates for general anesthesia, an opportunity to undergo this procedure.


METHODS
Using local anesthesia and nitrous oxide pneumoperitoneum, 175 catheters were implanted in long musculofascial tunnels under laparoscopic guidance to minimize the risk of catheter migration and flow dysfunction.


RESULTS
Nitrous oxide pneumoperitoneum was well tolerated, allowing all procedures to be safely completed with the patients under local anesthesia. The overall 1- and 2-year catheter survival rates were 92.7% and 91.3%, respectively. The incidence of catheter tip migration and omental entrapment was 1.7% and 2.9%, respectively. Temporary pericatheter leak occurred in 7.4% of cases.


CONCLUSIONS
Nitrous oxide insufflation enables safe performance of laparoscopic surgery with the patient under local anesthesia. Patients benefit from a minimally invasive technique with the assurance of obtaining successful long-term catheter function.
Department of Surgery, Imam Khomeini Hospital, Tehran, Iran. keshvari@tums.ac.ir
Amir
A
Keshvari
Iraj
I
Najafi
Mihan
M
Jafari-Javid
Masud
M
Yunesian
Reza
R
Chaman
Mohammadkazem Nouri
MN
Taromlou
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local; D002404:Catheterization / Q000295:instrumentation* / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009609:Nitrous Oxide / Q000008:administration & dosage*; D010530:Peritoneal Dialysis; D011028:Pneumoperitoneum, Artificial; D055815:Young Adult
D009609:Nitrous Oxide