Efficacy And Safety Evaluation Of A Minimally Invasive Laparoscopic Peritoneal Dialysis Catheter Insertion

Background:When a patient needs peritoneal dialysis(PD)treatment,peritoneal dialysis catheter(PDC)is used to establish access to the abdominal cavity and exchange substances with the help of peritoneal dialysis fluid.Whether PDC can maintain good drainage function is closely related to different catheter insertion methods.Advanced laparoscopic PDC implantation often has a lower incidence of postoperative catheter-related mechanical complications and a longer catheter survival compared with open surgery,percutaneous insertion and basic laparoscopic technique.Therefore,the advanced laparoscopic PDC insertion technique is recommended in clinical guidelines worldwide[1,2].It can be further improved in Trocar placement and catheter fixation in laparoscopic peritoneal dialysis catheter insertion.To further reduce surgery trauma and the incidence of catheter-related mechanical complications,we developed a minimally invasive laparoscopic PDC insertion technique on the basis of advanced laparoscopic technology.Objective:1.Innovatively improve the laparoscopic PDC insertion by using the Veress needle sheath for catheter fixation.2.Compare the differences in preoperative baseline indicators,surgery-related indicators,postoperative catheter-related complications,and catheter technical survival between patients who underwent minimally invasive laparoscopic PDC insertion and patients who underwent traditional open surgery and percutaneous insertion,and discuss the corresponding clinical significance.3.Discuss the technical advantages of the modified minimally invasive laparoscopic PDC insertion compared with other laparoscopic procedures,and evaluate the safety and efficacy of the new technique by comparing the incidence of catheter-related complications with traditional open surgery and percutaneous insertion.Methods:1.This retrospective study included patients who underwent PDC insertion in Qilu Hospital of Shandong University from November 2018 to August 2022 and continued to use PD after the insertion.According to the actual catheter insertion methods,the patients were divided into the open surgery group(received open surgical insertion),the percutaneous group(received percutaneous catheter insertion)and the laparoscopic group(received minimally invasive laparoscopic catheter insertion).2.The patient’s preoperative baseline data and intraoperative conditions were obtained from Qilu Hospital’s medical record management system.The incidence of postoperative catheter-related complications was obtained through searching follow-up records.The catheter-related complications included catheter obstruction,catheter migration,leakage,subcutaneous tunnel or skin exit-site infection,Peritoneal dialysis associated peritonitis(PDAP),hernia and so on within 6 months after surgery.IBM SPSS Statistics 25.0 software was used for statistical analysis.A P value of less than 0.05 was considered statistically significant.Results:1.A total of 135 patients were included in this study,including 47 in the laparoscopic group,64 in the percutaneous group,and 24 in the open surgery group.2.The operation time in the percutaneous group(70[60,90]min)was significantly longer than the laparoscopic group(50[40,65]min)and the open surgery group(55[50.0,72.5]min).The incision length was 1.5[1.5,2.0]cm in the laparoscopic group,1.0[1.0,1.0]cm in the percutaneous group,and 4.0[4.0,4.5]cm in the open surgery group.The difference in the incision length among the three groups was statistically significant.The interval from operation to starting PD in the percutaneous group(14[4,19]days)was significantly longer than the laparoscopic group(5[3,7]days)and the open surgery group(3[2,5]days).The time from operation to discharge in the laparoscopic group(7[5,10]days)was significantly longer than the percutaneous group(4.5[4,7]days).The use of postoperative analgesic drugs in the laparoscopic group(6.4%)was significantly lower than the open surgery group(29.2%).The surgery cost of the laparoscopic group(7792[7344,8182]yuan)was significantly higher than the percutaneous group(2515[2428,2595]yuan)and the open surgery group(2844[2371,3704]yuan).3.The incidence of catheter migration was 0%in the laparoscopic group,which was significantly lower than the open surgery group(16.7%).The incidence of catheter-related mechanical complications 6 months after operation in the laparoscopic group(6.4%)was significantly lower than the open surgery group(33.3%).4.Kaplan-Meier survival curve showed patients in the laparoscopic group has the longest catheter technical survival(Log Rank P=0.009).Logistic regression and Cox regression revealed that compared with open surgery,laparoscopic surgery showed a tendency to reduce catheter-related mechanical complications and increase catheter technical survival(OR=0.155,95%CI 0.036-0.667,P=0.012;HR=0.203,95%CI 0.053-0.778,P=0.020).5.There were no significant differences in preoperative baseline data among the three groups.There were no statistical differences in the incidence of catheter obstruction,leakage,incisional hernia,catheter-related infectious complications,subcutaneous tunnel or exit site infection,and PDAP among the three groups 6 months after surgery.Conclusion:1.The modified minimally invasive laparoscopic peritoneal dialysis catheter insertion achieves reliable fixation of PDC under direct vision with the help of Veress needle sheath.The omentum and adhesions can be bypassed during the operation,and the patients with previous surgical history can still effectively perform the minimally invasive laparoscopic technique,which breaks through the contraindications of traditional open surgery and percutaneous surgery.2.Compared with the traditional open surgery,the modified minimally invasive laparoscopic PDC insertion significantly reduced surgical trauma and the incidence of postoperative early catheter migration,catheter-related mechanical complications,and analgesic use.Catheter technical survival was longer.3.Compared with percutaneous technique,the operation time was obviously shortened,and the failed catheter can be reset and fixed under direct observation.4.The modified minimally invasive laparoscopic peritoneal dialysis catheter insertion has the ability to initiate PD treatment urgently with low postoperative complication rates.5.The novel technique showed the characteristics of simple,minimally invasive and better esthetics,and low complication rates.It is safe and effective and is worth promoting widely.