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Updated: May 22, 2026
Laparoscopic-Assisted Seldinger Technique for Peritoneal Dialysis Catheter Insertion
Published on: May 23, 2025
A comparative analysis of percutaneous and open surgical techniques for peritoneal catheter placement
Samar Medani1, Mohamed Shantier, Wael Hussein
1Nephrology, Adelaide and Meath Hospital, Dublin, Ireland. smedani@doctors.org.uk
Insights
Percutaneous peritoneal dialysis catheter (PDC) insertion shows promising results compared to surgical placement, with better 3-month survival. Further studies are needed to address patient selection biases.
Area of Science:
- Nephrology
- Surgical Procedures
- Medical Devices
Background:
- Peritoneal dialysis (PD) is a key renal replacement therapy for end-stage kidney disease.
- Long-term viability of the peritoneal dialysis catheter (PDC) is crucial for PD success.
- Bedside percutaneous PDC placement offers advantages like faster recovery and avoidance of general anesthesia, yet is underutilized.
Purpose of the Study:
- To compare the outcomes of percutaneous PDC insertions with traditional surgical PDC insertions.
- To evaluate the efficacy and safety of percutaneous PDC placement versus surgical placement in a real-world setting.
Main Methods:
- A retrospective analysis of 313 PDC insertions was conducted.
- Outcomes were compared between percutaneous PDC insertions (n=151) and surgical PDC insertions (n=162).
- Data analyzed included previous abdominal surgery, exit-site leaks, peritonitis, drainage issues, and technical survival rates.
Main Results:
- Percutaneous PDC placement (group P) demonstrated significantly better technical survival at 3 months (86.6% vs 77%, p=0.037) compared to surgical placement (group S).
- Group S had a higher incidence of peritonitis (1 episode/19 catheter-months vs 1 episode/26 catheter-months, p=0.017).
- Group P experienced more exit-site leaks (20.5% vs 6.8%, p=0.002), while drainage issues and early peritonitis rates were similar between groups.
Conclusions:
- Percutaneous PDC placement shows encouraging outcomes compared to open surgical placement, particularly in terms of early technical survival.
- Patient selection influenced comparability, as percutaneous group patients were less likely to have prior abdominal surgery or PDC insertion.
- Further research is required to address confounding factors and assess the generalizability of percutaneous PDC placement outcomes.
Background:
Peritoneal dialysis (PD) is the preferred available option of renal replacement therapy for a significant number of end-stage kidney disease patients. A major limiting factor to the successful continuation of PD is the long-term viability of the PD catheter (PDC). Bedside percutaneous placement of the PDC is not commonly practiced despite published data encouraging use of this technique. Its advantages include faster recovery and avoidance of general anesthesia.
Methods:
We carried out a retrospective analysis of the outcomes of 313 PDC insertions at our center, comparing all percutaneous PDC insertions between July 1998 and April 2010 (group P, n = 151) with all surgical PDC insertions between January 2003 and April 2010 (group S, n = 162).
Results:
Compared with group P patients, significantly more group S patients had undergone previous abdominal surgery or PDC insertion (41.8% vs 9.3% and 33.3% vs 3.3% respectively, p = 0.00). More exit-site leaks occurred in group P than in group S (20.5% vs 6.8%, p = 0.002). The overall incidence of peritonitis was higher in group S than in group P (1 episode in 19 catheter-months vs 1 episode in 26 catheter-months, p = 0.017), but the groups showed no significant difference in the peritonitis rate within 1 month of catheter insertion (5% in group P vs 7.4% in group S, p = 0.4) or in poor initial drainage or secondary drainage failure (9.9% vs 11.7%, p = 0.1, and 7.9% vs 12.3%, p = 0.38, for groups P and S respectively).Technical survival at 3 months was significantly better for group P than for group S (86.6% vs 77%, p = 0.037); at 12 months, it was 77.7% and 68.7% respectively (p = 0.126). No life-threatening complications attributable to the insertion of the PDC occurred in either group.
Conclusions:
Our analysis demonstrates further encouraging outcomes of percutaneous PDC placement compared with open surgical placement. However, the members of the percutaneous insertion group were primarily a selected subset of patients without prior abdominal surgery or PDC insertion, therefore limiting the comparability of the groups. Studies addressing such confounding factors are required. Local expertise in catheter placement techniques may affect the generalizability of results.
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