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  • Laparoscopic implantation of distal peritoneal ventriculo-peritoneal shunt catheter - A prospective comparative Study

    Final Number:

    Or Cohen-Inbar MD; Eric Cochran; Uri Hadelsberg; Michael Krausz; Menashe Zaaroor MD DSc; Ahmad Mahajna

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: Ventriculo-peritoneal shunts (VPS) are a common treatment for hydrocephalus. Placement of the distal abdominal catheter can be difficult in the setting of advanced age, previous shunt or abdominal surgeries, obesity, chronic illnesses etc. at our institute, part of the procedures are performed using a multidisciplinary team of a neurosurgeon and a laparoscopic surgeon. We evaluated the influence on prognosis of a laparoscopically assisted VPS placement using a single-port technique as compared to the conventional mini-laparotomy approach.

    Methods: A retrospective review of all patients admitted and operated at our institute for hydrocephalus or shunt dysfunction during 2006-2010 was performed, forming a cohort of 302 patients, 48 with single trocar laparoscopy. Neurosurgeons and laparoscopic surgeons logged the presenting symptoms, past medical history, chronic illnesses and past surgical procedures. Surgical procedure and findings were logged as well. Outcome data was collected at several time points after the surgical intervention.

    Results: The laparoscopic patients group was significantly much older, had more chronic illnesses and had significantly more prior abdominal and shunt operations. And still, this group had the same outcome as the open minilaparotomy group, expressed in several independent outcome parameters.

    Conclusions: Elderly patients or those suffering less optimally controlled chronic illnesses and obesity, as well as those patients who underwent previous abdominal or shunt operations may benefit from the laparoscopic single port technique for distal catheter placement during VPS procedure. This is shown to reduce the surgical complications and equals the outcome parameters to those of the young, otherwise healthy patients.

    Patient Care: evidence based decision making in VPS operations. proof for the superiority of a multi-disciplinary patient approach

    Learning Objectives: compare two approaches for a common procedure.

    References: 1. Hydrocephalus, in Mark S.Greenberg (ed): Handbook of Neurosurgery. New-York, Thieme, 2006, pp 180-207. 2. Argo JL, Yellumahanthi DK, Ballem N, Harrigan MR, Fisher WS, III, Wesley MM, Taylor TH, Clements RH (2009): Laparoscopic versus open approach for implantation of the peritoneal catheter during ventriculoperitoneal shunt placement. Surg Endosc:1449-1455. 3. Bondurant CP, Jimenez DF: Epidemiology of cerebrospinal fluid shunting (1995). Pediatr Neurosurg:254-258. 4. Fanelli RD, Mellinger DN, Crowell RM, Gersin KS (2000): Laparoscopic ventriculoperitoneal shunt placement: a single-trocar technique. Surg Endosc:641-643. 5. Kaye A: Essential Neurosurgery, Blackwell, 2005, pp 27-40. 6. Khaitan L, Brennan EJ, Jr. (1999): A laparoscopic approach to ventriculoperitoneal shunt placement in adults. Surg Endosc:1007-1009. 7. Khosrovi H, Kaufman HH, Hrabovsky E, Bloomfield SM, Prabhu V, el-Kadi HA (1998): Laparoscopic-assisted distal ventriculoperitoneal shunt placement. Surg Neurol:127-134. 8. Reardon PR, Scarborough TK, Matthews BD, Marti JL, Preciado A (2000): Laparoscopically assisted ventriculoperitoneal shunt placement using 2-mm instrumentation. Surg Endosc:585-586. 9. Reimer R, Wharen RE, Jr., Pettit PD (1998): Ventriculoperitoneal shunt placement with video-laparoscopic guidance. J Am Coll Surg:637-639. 10. Roth J, Sagie B, Szold A, Elran H (2007): Laparoscopic versus non-laparoscopic-assisted ventriculoperitoneal shunt placement in adults. A retrospective analysis. Surg Neurol:177-184. 11. Roth JS, Park AE, Gewirtz R (2000): Minilaparoscopically assisted placement of ventriculoperitoneal shunts. Surg Endosc:461-463. 12. Schubert F, Fijen BP, Krauss JK (2005): Laparoscopically assisted peritoneal shunt insertion in hydrocephalus: a prospective controlled study. Surg Endosc:1588-1591. 13. Turner RD, Rosenblatt SM, Chand B, Luciano MG (2007): Laparoscopic peritoneal catheter placement: results of a new method in 111 patients. Neurosurgery:167-172.

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