title: Comparison of peritoneal dialysis catheter insertion techniques: Peritoneoscopic, radiological and laparoscopic : A single-centre study.
abstract: BACKGROUND
  Our centre introduced peritoneoscopic insertion of peritoneal dialysis (PD) catheter by nephrologists as a new method in August 2009 for its potential benefits.
  
  
  OBJECTIVE
  The aim of this study was to compare perioperative complications and catheter survival of three techniques: peritoneoscopic, surgical and radiological techniques within a single dialysis centre.
  
  
  METHODS
  This study used retrospective analysis of all PD catheter inserted from 1 August 2009 to 31 July 2013 within Counties Manukau DHB, Auckland, New Zealand.
  
  
  RESULTS
  During the study period, 293 PD catheters were inserted, 84 (29%) peritoneoscopic (P), 140 (48%) surgical (S) and 69 (23%) radiological (R). Total duration of follow-up was 5848 catheter-months, with median follow-up of 17 months. There was no difference in perioperative exit-site infections and overall early infections. There was however increased overall perioperative complications in P compared with R (HR 2.08; P < 0.05), predominantly from catheter removal within 60 days. Although there was no difference observed in first catheter 1-year and overall survival between insertion techniques, there was poorer complication-free survival comparing P to S (HR 1.82, P = 0.001) but not to R. Analyses of the latter cohort of P confirmed improvement in catheter survival compared with an earlier cohort and to other insertion techniques.
  
  
  CONCLUSIONS
  Peritoneoscopic PD catheter insertion is demonstrated to be a suitable alternative technique. As with any new procedure, 'learning curve' effects and development of operator expertise need to be taken into consideration.
authors.affiliation: Department of Renal Medicine, Counties Manukau DHB, Auckland, New Zealand.
authors.forename: Tina Y-T
authors.initials: TY
authors.lastname: Sun
authors.affiliation: Department of Renal Medicine, Counties Manukau DHB, Auckland, New Zealand.
authors.forename: David
authors.initials: D
authors.lastname: Voss
authors.affiliation: Department of Renal Medicine, Counties Manukau DHB, Auckland, New Zealand.
authors.forename: Denise
authors.initials: D
authors.lastname: Beechey
authors.affiliation: Department of Renal Medicine, Counties Manukau DHB, Auckland, New Zealand.
authors.forename: Michael
authors.initials: M
authors.lastname: Lam-Po-Tang
mesh_terms: D000328:Adult; D000368:Aged; D055499:Catheter-Related Infections / Q000209:etiology; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D002408:Catheters, Indwelling; D002983:Clinical Competence; D020878:Device Removal; D018572:Disease-Free Survival; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000628:therapy*; D010535:Laparoscopy / Q000009:adverse effects; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D015641:Radiography, Interventional / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: catheter outcomes; catheter survival; peritoneal dialysis; peritoneoscopic catheter insertion