title: Laparoscopic placement of distal ventriculoperitoneal shunt catheters.
abstract: OBJECTIVE
  Ventriculoperitoneal shunts (VPSs) are commonly placed into the peritoneal cavity via a small laparotomy or blindly by using a split trocar. Larger patients require larger incisions, and placement is made more difficult by previous abdominal operations and obesity. For general surgeons, laparoscopy has become the first-choice approach for abdominal procedures, using 1 or several very small incisions. The authors discuss their pediatric series of patients in whom laparoscopy was used to place distal shunt catheters.
  
  
  METHODS
  The authors reviewed the medical records accrued over a 9-year period, noting VPS operations performed using laparoscopy. Complications, morbidity, and alterations of planned management were noted.
  
  
  RESULTS
  One hundred thirty-seven VPS operations in 126 patients were identified, 92 performed by the senior author (M.H.H.) alone and 45 conducted with the assistance of a general surgeon. A second port was placed for lysis of adhesions or retrieval of old catheters in 7 cases. There were no immediate complications. The infection rate was 6.6%, comparable with the institutional norm (6.3%) over an 8-year period. There were 3 early failures due to abdominal malabsorption without infection. Five catheters later broke at the level where they were introduced into the abdomen due to shearing by the abdominal trocar.
  
  
  CONCLUSIONS
  Laparoscopic placement of distal VPS catheters is relatively safe and allows insertion via inconspicuous incisions. It can allow for inspection or lysis of adhesions and removal of foreign bodies, help determine if and where the abdomen can absorb shunt fluid, and make VPS surgery in the obese patient easier.
authors.affiliation: Department of Neurosurgery, The Children's Hospital, and University of Colorado School of Medicine, Aurora, Colorado 80045, USA. handler.michael@tchden.org
authors.forename: Michael H
authors.initials: MH
authors.lastname: Handler
authors.forename: Brian
authors.initials: B
authors.lastname: Callahan
mesh_terms: D000293:Adolescent; D000328:Adult; D002404:Catheterization; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D008297:Male; D017287:Ventriculoperitoneal Shunt / Q000379:methods*