Introduction: Laparoscopic assistance for placement of ventriculoperitoneal (VP) shunts has been suggested to have comparable outcomes as compared to the mini-laparotomy technique. The use of laparoscopic assistance has also been shown to potentially have lower rates of distal shunt malfunction. Despite the perceived equivalence in safety with laparoscopic assistance, there are concerns about potential for higher infection rates given the presence of more surgeons in the operating room. There are also concerns about increased costs to the patient, especially with use of laparoscopic equipment and potentially increased operating room time.

Methods: A retrospective analysis of 235 consecutive adult VP shunt cases at our institution from 2012-2017 was performed. Only cases where a new VP shunt system (proximal and distal catheters) was placed were included in the analysis, which yielded a total of 106 cases. These cases were divided into two groups: laparascopic-assisted and mini-laparotomy. Operating time, blood loss, and postoperative complications were compared between both groups. The average operative time and blood loss in each group were compared using Student's t-test. The postoperative complication rates were compared using two-tailed Fisher’s exact test. P value <0.05 was considered statistically significant.

Results: There were 44 VP shunts placed with laparoscopic assistance and 62 VP shunts placed using mini-laparotomy technique. The summary of baseline characteristics of the patients in the two groups is shown in Table 1. There was no significant difference in average blood loss between the two groups. However, there was a significant difference in average OR time; 113 minutes in the laparoscopic group vs. 96 minutes in the mini-laparotomy group (p=0.03). In terms of postoperative complications, there was not a significant difference in distal or proximal shunt malfunctions (see Table 2). Despite lack of statistical significance, there may be a trend towards higher infection rate in the laparoscopic group (6.8% vs. 1.6% in the mini-laparotomy group).

Conclusions: Laparoscopic-assisted placement of VP shunts may incur greater costs to the patient due to longer OR time. Laparoscopic assistance may also be associated with higher risk of shunt infection.

Patient Care: This research may provide guidance for practitioners who want to reduce costs to adult patients who require VP shunt placement.

Learning Objectives: By the conclusion of this session, participants should be able to: 1) Recognize the increased costs for patients who undergo laparoscopic-assisted VP shunts. 2) Recognize the potential increased risk of infection with laparoscopic-assisted VP shunts due to increased number of surgeons in the OR.

References: 1. Raysi Dehcordi S, De Tommasi C, Ricci A, Marzi S, Ruscitti C, Amicucci G, et al. Laparoscopy-assisted ventriculoperitoneal shunt surgery: personal experience and review of the literature. Neurosurg Rev 34(3):363-371, 2011. 2. Roth J, Sagie B, Szold A, Elran H. Laparoscopic versus non-laparoscopic-assisted ventriculoperitoneal shunt placement in adults. A retrospective analysis. Surgical Neurology 68(2):177-184, 2007. 3. Schucht P, Banz V, Trochsler M, Iff S, Krahenbuhl AK, Reinert M, et al. Laparoscopically assisted ventriculoperitoneal shunt placement: a prospective randomized controlled trial. J Neurosurg 122:1058-1067, 2015.