Laparoscopic peritoneal dialysis catheter insertion using nitrous oxide under procedural sedation.

Area of Science:

• Nephrology
• Minimally Invasive Surgery
• Gastroenterology

Background:

• Conventional peritoneal dialysis catheter (PD) insertion methods have limitations.
• Laparoscopic peritoneal dialysis catheter (LPDC) implantation with nitrous oxide (N2O) pneumoperitoneum under procedural sedation offers advantages.
• This study reviews LPDC insertion outcomes at our center.

Purpose of the Study:

• To review the results of laparoscopic peritoneal dialysis catheter insertion at our center.
• To evaluate the safety and efficacy of N2O pneumoperitoneum for LPDC implantation.
• To assess catheter-related functional outcomes and complications.

Main Methods:

• Retrospective review of 87 consecutive LPDC insertions.
• Procedures performed under procedural sedation with local anesthesia and N2O pneumoperitoneum.
• Rectus sheath tunneling for catheter advancement, with laparoscopy for position confirmation and adjunct procedures as needed.

Main Results:

• N2O was well tolerated in 94% of patients; only 5 required general anesthesia.
• Mean follow-up of 18.2 months revealed low rates of mechanical complications (e.g., leakage, obstruction, hernia) and infectious complications (exit site infection, peritonitis).
• Revision-free catheter survival was 97.6% after 1 year.

Conclusions:

• Laparoscopic PD catheter implantation with N2O pneumoperitoneum and local anesthesia is safe and effective for patients with severe renal failure.
• N2O is a well-tolerated, inert insufflation agent enabling awake procedures.
• Catheter functional outcomes are comparable to existing literature, making this a recommended option for dialysis catheter implantation.