Laparoscopic Peritoneal Dialysis Catheter Insertion Using Nitrous Oxide Under Conscious Sedation: A Safe and Effective Alternative of Implantation

Robert Wu, Allan Okrainec, Todd Penner. DEPARTMENT OF SURGERY, UNIVERSITY HEALTH NETWORK, UNIVERSITY OF TORONTO

Introduction: Laparoscopic peritoneal dialysis catheter (LPDC) implantation using nitrous oxide (N2O) under conscious sedation is a procedure that has many advantages over conventional insertion methods. The purpose of this study was to review the LPDC insertion results at our center.

Methods: Data from 86 consecutive patients undergoing LPDC insertion at our institution was retrospectively reviewed. All procedures were performed under conscious sedation. After patients received local anesthesia, a nitrous oxide (N2O) pneumoperitoneum was established. PD catheters were advanced using rectus sheath tunneling. Position of the catheter was confirmed by laparoscope and adjunct procedures such as omentopexy and adhesiolysis were performed on selective patients to prevent catheter flow problems.

Results: Nitrous oxide was well tolerated intraoperatively without complications. After a mean follow-up of 18.2 months, mechanical complications included pericatheter/incision leakage (2.4%), incision/exit site (3.5%), flow obstruction (4.6%), hemoperitoneum (2.3%), pleuroperitoneul fistula (1.2%), hydrothorax (1.2%), scrotal leak (1.2%), and migration (1.2%). Infective complications include exit site infection (4.6%) and peritonitis (32.5%). Revision free catheter survival is 97.6% after 1 year.

Conclusion: Laparoscopic implantation of PD catheter with N2O insufflation and local anesthesia is safe and effective in patients with severe renal failure. N2O is an inert gas and better tolerated as an insufflation agent, enabling awake procedures. Our results show that catheter-related functional outcomes are comparable to the existing open literature. This approach can be recommended as a good option of catheter implantation in patients needing dialysis.


Session: Poster
Program Number: P476
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