Ventriculoperitoneal Shunt Placement: Single Port Laparoscopic Technique

Jagpreet S Deed, MS, DNB, MRCS, Gen, Surg1, Ashish K Srivastav, MCh, Neurosurgery, MS, General, Surg2, Vivek Bindal, MRCS, Fellowship, MAS, Endoscopy, FNB3. 1Zulekha hospital, Sharjah, UAE, 2Rockland hospital, 3Sir Ganga Ram Hospital

Background: Distal failure of ventriculoperitoneal shunt can be as high as 10-30%. Proper intraperitoneal placement can be challenging especially in patients with previous adhesions.

Objective : To evaluate the utility of single port laparoscopic technique for ventriculoperitoneal shunt placement.

Methodology: Since Nov 2004, 14 patients requiring Ventriculoperitoneal shunt underwent single port laparoscopic placement after informed consent. During this novel technique, the VP shunt introducer was rail roaded through single umbilical laparoscopic port under direct vision. It involved assistance and manipulation by external manual pressure over skin to guide the introducer under laparoscopic vision. Hence, the procedure could be completed without use of any laparoscopic instrument except laproscope.

Results: Average operative time for laparoscopic part was 19 minutes. Oral intake was started on same day and discharge after 2 days. One year follow-up was available for 15 patients and was satisfactory.

Conclusions: Single port laparoscopic placement of Ventriculoperitoneal shunt is feasible. It carries advantages of placement under direct vision, in situ testing, reduced trauma and less risk of intra-abdominal adhesions.

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