title: Laparoscopic peritoneal dialysis catheter insertion using nitrous oxide under procedural sedation.
abstract: BACKGROUND
  Laparoscopic peritoneal dialysis catheter (LPDC) implantation using nitrous oxide (N2O) pneumoperitoneum under procedural sedation is a technique that has many advantages over conventional insertion methods. The purpose of this study was to review the LPDC insertion results at our center.
  
  
  METHODS
  Data from 87 consecutive patients who underwent LPDC insertion was retrospectively reviewed. All procedures were attempted under procedural sedation. After patients received intravenous and local anesthesia, a N2O pneumoperitoneum was established. Peritoneal dialysis (PD) catheters were advanced using rectus sheath tunneling. The position of the catheter was confirmed by laparoscope, and adjunct procedures such as omentopexy and adhesiolysis were performed on select patients to prevent catheter flow problems.
  
  
  RESULTS
  Nitrous oxide was well tolerated by 94 % of the patients. Only five patients required conversion to general anesthesia. After a mean follow-up of 18.2 months, mechanical complications included pericatheter/incision leakage (12.62 %), flow obstruction (4.60 %), incision/exit site hernia (3.45 %), hemoperitoneum (2.30 %), pleuroperitoneal fistula (1.15 %), scrotal leak (1.15 %), and migration (1.15 %). Infectious complications included exit site infection (1 episode per 312.95 patient-months) and peritonitis (1 episode per 31.93 patient-months). Revision-free catheter survival was 97.6 % after 1 year.
  
  
  CONCLUSIONS
  Laparoscopic implantation of a PD catheter with N2O pneumoperitoneum and local anesthesia is safe and effective in patients with severe renal failure. N2O is an inert gas and better tolerated as an insufflation agent, enabling awake procedures. Our results show that catheter-related functional outcomes are comparable to those in the existing literature. This approach can be recommended as a good option for catheter implantation in patients needing dialysis.
authors.affiliation: University of Ottawa, The Ottawa Hospital - General Campus, 501 Smyth Rd., Ottawa, ON, K1H 8L6, Canada, rowu@toh.on.ca.
authors.forename: Robert
authors.initials: R
authors.lastname: Wu
authors.forename: Allan
authors.initials: A
authors.lastname: Okrainec
authors.forename: Todd
authors.initials: T
authors.lastname: Penner
mesh_terms: D000328:Adult; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D002404:Catheterization / Q000379:methods*; D057785:Catheters; D002408:Catheters, Indwelling; D016292:Procedural Sedation / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009609:Nitrous Oxide / Q000627:therapeutic use; D010530:Peritoneal Dialysis / Q000379:methods*; D011028:Pneumoperitoneum, Artificial; D011183:Postoperative Complications; D012189:Retrospective Studies
chemical_list: D018712:Analgesics, Non-Narcotic; D009609:Nitrous Oxide