title: Modern paradigm for peritoneal catheter insertion: single port optical access laparoscopic shunt insertion.
abstract: BACKGROUND
  Ventriculoperitoneal shunting is one of the most commonly performed neurosurgical procedures. Typically, for insertion of the peritoneal catheter, a mini-laparotomy technique is used. Although generally safe, it can be cosmetically undesirable and time consuming. Complications include malpositioning, bowel injury, and delayed hernias. Laparoscopic techniques have been advocated to address these issues, but have been slow to gain traction with neurosurgeons.
  
  
  OBJECTIVE
  To describe our experience with single port optical access laparoscopy for placement of ventriculoperitoneal shunts. Our technique simplifies adoption of a laparoscopic technique for neurosurgeons looking to incorporate its benefits.
  
  
  METHODS
  All ventriculoperitoneal shunts placed by the senior author since April 2011 were retrospectively reviewed. Surgical and perioperative complications, length of postoperative stay, and need for revisions were analyzed.
  
  
  RESULTS
  Fifty-six patients were included in the study. There were no cases of peritoneal catheter misplacement. One intraoperative complication occurred early in the series, in which there was an injury to the gallbladder necessitating cholecystectomy. There were 7 cases followed by shunt revision inclusive of the abdomen. In 3 cases, pseudocysts were noted.
  
  
  CONCLUSIONS
  Single port optical access laparoscopy is a fast and minimally invasive technique that allows direct visualization of the layers of the abdominal wall as they are traversed and visualization of the peritoneal catheter during placement. It uses a small cosmetic incision and obviates the need for postoperative abdominal radiographic studies. The procedure has a modest learning curve, but can be safely used without the assistance of an assist surgeon after the skills are acquired.
authors.affiliation: Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Jacob
authors.initials: J
authors.lastname: Cherian
authors.forename: Jared S
authors.initials: JS
authors.lastname: Fridley
authors.forename: Edward A M
authors.initials: EA
authors.lastname: Duckworth
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D010529:Peritoneal Cavity / Q000601:surgery*; D011184:Postoperative Period; D012189:Retrospective Studies; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects / Q000379:methods*