Document Detail

Laparoscopic ventriculoperitoneal shunt placement: a single-trocar technique.
MedLine Citation:
PMID:  10948300     Owner:  NLM     Status:  MEDLINE    
Ventriculoperitoneal shunt (VPS) placement is an important therapeutic technique. Placement of the abdominal portion of VPS can be difficult in the setting of previous abdominal surgery, prior failure of VPS, or obesity. Even under ideal circumstances, standard mini-laparotomy does not allow precision in VPS positioning. We describe a single-port technique for VPS placement. While the neurosurgeon places a right frontal ventricular catheter and valve, an infraumbilical trocar is placed utilizing the open Hasson technique. A 12-mm operating laparoscope with an 8-mm channel is used to inspect the abdomen and identify the VPS entry site. Adhesions interfering with shunt placement can be lysed through the working channel of the laparoscope. Under laparoscopic visualization, an 18-gauge needle is introduced through a 5-mm incision in the right upper quadrant and the VPS tubing is tunneled to that site. A J-tipped guidewire is introduced, and the needle is exchanged for a dilator and peel-away sheath. The VPS is delivered through the sheath, which is sectioned and removed. An atraumatic grasper, placed through the laparoscope, directs the VPS to the desired intraabdominal location. Function of the VPS is assessed visually while compressing the valve. Suture closure of the trocar site and VPS entry site completes the procedure. We used this method successfully in a series of five patients with excellent outcome. A 14-month follow-up has revealed no failures or postoperative complications. This method is less invasive than mini-laparotomy, allows for precision placement of the abdominal portion of VPS, and confirms appropriate function.
R D Fanelli; D N Mellinger; R M Crowell; K S Gersin
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Surgical endoscopy     Volume:  14     ISSN:  0930-2794     ISO Abbreviation:  Surg Endosc     Publication Date:  2000 Jul 
Date Detail:
Created Date:  2001-02-02     Completed Date:  2001-02-02     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8806653     Medline TA:  Surg Endosc     Country:  GERMANY    
Other Details:
Languages:  eng     Pagination:  641-3     Citation Subset:  IM    
Department of Surgery, University of Massachusetts Medical School at Berkshire Medical Center, Surgical Specialists of Western New England PC, Pittsfield 01201, USA.
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MeSH Terms
Equipment Design
Follow-Up Studies
Surgical Instruments
Ventriculoperitoneal Shunt / methods*

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