Improvement Of Peritoneal Catheter Placement In Ventriculoperitoneal Shunt Surgery With A Splitable Trocar:a Randomized,Controlled Clinical Study

Purpose:Currently,the vast majority of neurosurgeons performing ventriculoperitoneal shunt surgery(VPS)still use small abdominal incisions to place catheters,which is inconsistent with the concept of "minimally invasive" surgery.This results in long operative times,high patient trauma,and postoperative complications.Therefore,some investigators have attempted to use laparoscopic-assisted placement of catheters in ventriculoperitoneal shunts.However,the results of several studies have shown that although laparoscopic-assisted placement reduces the incidence of distal placement failure compared with traditional small-incision open placement,it does not achieve a reduction in the overall bypass failure rate in patients.In addition,the high operational threshold of laparoscopy causes laparoscopy-assisted VPS to be difficult to be widely used.For these reasons,we designed a splitable trocar and initially investigated the safety and feasibility of using a a splitable trocar to improve the placement of a peritoneal catheter placement in VPS.METHODS:Patients with hydrocephalus requiring ventriculoperitoneal shunts were selected according to inclusion and exclusion criteria and randomly divided into open mini-laparotomy group(OLG)and a the abdominal puncture group(APG).In the OLG and APG,the splitable trocar was used for the placement of the ventriculoperitoneal end catheter and the open small incision was used for the placement of the catheter,respectively.The primary endpoints were the overall shunt failure rate and the distal catheter shunt failure rate at 6 months postoperatively.Secondary endpoints were the occurrence of adverse events(e.g.,fever,vomiting,excessive drainage,etc.),length of abdominal end catheter placement,length of abdominal incision,degree of postoperative abdominal pain with the need for pain medication in the bout,location of the distal catheter opening,total length of stay and cost,costs associated with the procedure directly,and evaluation of patient prognosis and ability to live.All statistics were analyzed using the t-statistical software SPSS version 22.0(SPSS Inc.,Chicago,Illinois,USA).Descriptive analyses were expressed as mean ±standard deviation,,frequency(percentage),and tests were performed using t-test,chi-square test or Fisher’s exact probability method,and rank sum test for comparison between groups.p-values less than 0.05 indicated statistically significant differences in components.RESULTS:A total of 40 patients were followed for a 6-month period.In the open mini-laparotomy group,one case of shunt failure occurred due to shunt valve obstruction,and the shunt tube was replaced.No shunt failures occurred in the abdominal puncture group during the 6-month follow-up period Adverse reactions were reported in 9 cases in the APG and 10 cases in the OLG,with one severe adverse reaction in each group(p=0.752,p>0.05).The abdominal incision lengths for the OLG and APG were 5.43±0.474cm 和 0.67±0.310cm,respectively(p<0.0001).The catheter placement duration for the OLG and APG were 26.07±2.508 and 5.43±0.781 minutes,respectively(p<0.0001).,The numerical pain scores of the two groups were calculated by rank sum test(p=0.036<0.05),and the difference in the degree of abdominal pain between the two groups was statistically significant.In the APG,14 cases had the peritoneal end catheter opening below the umbilical plane,and 6 cases had it above the umbilical plane.In the OLG,5 cases had the peritoneal end catheter opening below the umbilical plane,and 15 cases had it above the umbilical plane(p=0.010,p<0.05).There were no statistically significant differences between the two groups in terms of total hospital stay,postoperative hospital stay,total hospital costs,surgery-related expenses,patient prognosis,and functional capacity evaluation.CONCLUSION:There is no significant difference in the overall shunt failure rate and distal catheter shunt failure rate between the two methods,suggesting that the abdominal end placement of VPS with a splitable trocar is safe.In addition,the method of placing the abdominal end of VPS with a splitable trocar can greatly shorten the operation time,reduce the length of the incision,and is conducive to the early rehabilitation of patients after surgery,suggesting its advantages over the traditional abdominal small incision catheterization method,showing its good clinical application prospects.It is necessary to conduct multi-center,large sample,randomized and controlled studies to further verify its safety and efficacy.