title: Introduction of a new laparoscopic trocar for insertion of peritoneal dialysis catheters and making a proper rectus sheath tunneling.
abstract: Using a proper laparoscopic trocar for making a downward rectus sheet tunneling (RSHT) during the implementation of peritoneal dialysis (PD) catheters leads to a longer survival of catheter and less catheter dysfunction. As no specific laparoscopic trocar has been invented for insertion of PD catheters, we designed a new trocar. In this article, we describe specifications of our new invented trocar for the first time. We will describe our experience with it in our patients as well.
  
  
  
  The new stainless steel trocar includes a cannula and a mandarin. The cannula consists of a tube pipe and head. The tube pipe is so long that is proper for rectus sheet tunneling, and its internal diameter is fitted for easy passage of the catheter with its cuffs. The head consists of two steel parts holding a unidirectional plastic valve preventing backflow of the air. The mandarin section includes a sharp shaft and a metal cap. The distal end of the mandarin is an atraumatic conical tip which was designed to make a safe RSHT.
  
  
  
  A total of 30 PD catheters were successfully implanted through 30 laparoscopic procedures in 12 males and 18 females (mean age 48.16 ± 14.18 years). All catheters were successfully inserted without any intraoperative complication. Exit-site infection, peri-catheter leakage, and outflow failure were found in two, one, and one patient, respectively. We did not find any inflow failure, catheter malpositioning, migration, or kinking. No other complication was observed during the 1-year follow-up period.
  
  
  
  The new designed PD trocar is a proper port for laparoscopic implantation of the peritoneal dialysis catheter. It is a safe and easy handle trocar that helps surgeons to make an appropriate rectus sheath tunneling with minimal complications.
authors.affiliation: Department of Surgery, Tehran University of Medical Sciences, Imam Khomeini Complex Hospital, Keshavarz Blvd., Tehran, Iran.
authors.forename: Amir
authors.initials: A
authors.lastname: Keshvari
authors.affiliation: Department of Surgery, Tehran University of Medical Sciences, Imam Khomeini Complex Hospital, Keshavarz Blvd., Tehran, Iran. dr_morezak@yahoo.com.
authors.forename: Mohammad Reza
authors.identifier: 0000-0003-0099-7114
authors.initials: MR
authors.lastname: Keramati
authors.affiliation: Department of Surgery, Tehran University of Medical Sciences, Imam Khomeini Complex Hospital, Keshavarz Blvd., Tehran, Iran.
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Nassajian
authors.affiliation: Department of Surgery, Tehran University of Medical Sciences, Imam Khomeini Complex Hospital, Keshavarz Blvd., Tehran, Iran.
authors.forename: Mehrzad
authors.initials: M
authors.lastname: Mohsenipour
authors.affiliation: Department of Surgery, Tehran University of Medical Sciences, Imam Khomeini Complex Hospital, Keshavarz Blvd., Tehran, Iran.
authors.forename: Mohammad Kazem
authors.initials: MK
authors.lastname: Nouritaromlou
mesh_terms: D000328:Adult; D000368:Aged; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D002408:Catheters, Indwelling; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000295:instrumentation* / Q000379:methods; D013525:Surgical Instruments / Q000009:adverse effects*
keywords: Laparoscopy; Peritoneal dialysis; Rectus abdominis; Trocar