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Updated: Jun 25, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Laparoscopic-assisted placement of ventriculo-peritoneal shunt tips in children with multiple previous open abdominal
1Department of Otolaryngology, Head and Neck Surgery, Childrens Hospital Missouri Healthcare, Columbia, MO, USA.
Insights
Laparoscopic revision of ventriculo-peritoneal shunts (VPS) is safe and effective in children with multiple prior surgeries. This approach offers improved visualization, reduces hospital stays, and minimizes complications for pediatric hydrocephalus patients.
Area of Science:
- Pediatric Surgery
- Neurosurgery
- Minimally Invasive Procedures
Background:
- Ventriculo-peritoneal shunt (VPS) placement is standard for pediatric hydrocephalus.
- Multiple VPS revisions are often necessary.
- Laparoscopy was previously considered contraindicated for complex VPS revisions.
Purpose of the Study:
- To evaluate the safety and efficacy of laparoscopy for VPS revision in children with multiple prior surgeries.
- To demonstrate that laparoscopy can be performed effectively in challenging revision cases.
Main Methods:
- Laparoscopically assisted VPS peritoneal portion placement in 8 children (7 months–18 years) with >2 prior VPS operations.
- Shunt placement in adhesion-free areas with direct visualization.
- Procedures performed between May 2003 and September 2007.
Main Results:
- All 8 procedures were successful without conversion to open surgery.
- No abdominal injuries were observed.
- Average hospital stay was 2.6 days; no abdominal revisions needed post-laparoscopy.
- Lysis of adhesions was required in 6 patients; 1 patient had a previously unknown complication corrected.
Conclusions:
- Laparoscopic VPS revision is safe and effective in children with multiple prior surgeries.
- Improved visualization allows placement in optimal abdominal regions.
- The laparoscopic approach corrects complications, reduces pain, shortens hospital stays, and lowers complication rates.
Background:
Placing a ventriculo-peritoneal shunt in children with hydrocephalus is the standard of care. Many of these children will require revision of this portion of the shunt for a variety of reasons. Previously, it was thought that in a child with multiple previous ventriculo-peritoneal shunt (VPS) revisions, laparoscopy was contraindicated. This study aims to show that laparoscopy can be used safely and effectively in children with multiple previous ventriculo-peritoneal shunt surgeries.
Materials And Methods:
Laparoscopically assisted placement of the peritoneal portion of the ventriculo-peritoneal shunt in children with multiple previous VPS revisions was performed in 8 consecutive children (4 female) with ages ranging from 7 months to 18 years between May 2003 and September 2007. All eight children had undergone more than two previous VPS operations. All shunts were placed in areas free of adhesions and flow was observed under direct visualization.
Results:
All of the procedures were successful; none needed conversion to the standard mini-laparotomy approach. No obvious or occult injury to the abdominal components was noted during hospitalization or during follow-up. Six of 8 patients required lysis of adhesions at the time of the revision. Average length of hospital stay was 2.6 days and no revisions of the abdominal portion of the VPS have been required by any of the 8 patients after laparoscopic revision. Previously unknown complications of shunt surgery were corrected in 1 of 8 children.
Conclusions:
Laparoscopic placement of the peritoneal portion of a ventriculo-peritoneal shunt can be done safely and effectively in children with multiple previous VPS revisions due to improved visualization and placement of the shunt tip in a virgin area of the abdomen. Additionally, any known or unknown complications from previous VPS surgeries can be corrected with the laparoscopic approach. When combined with the reduction in pain, shorter hospital stay, and fewer immediate and future complications, this is the procedure of choice for patients requiring revision VPS surgeries in our hospital.
