How I do laparoscopic insertion of the peritoneal catheter in a ventriculoperitoneal shunt

Insertion of a ventriculoperitoneal (VP) shunt requires surgical access to the peritoneal cavity to internalise the distal catheter. Classically this involved a 3 to 5 cm incision in the right upper quadrant, but the late 1990 s saw the introduction of laparoscopic techniques for distal catheter insertion and these have a number of advantages. We provide step by step descriptions of a straightforward technique to obtain pneumoperitoneum by a periumbilical approach. Once pneumoperitoneum is obtained, there are several simple methods for insertion of the distal catheter into the right upper quadrant (or elsewhere) under direct laparoscopic vision. This easy reference guide to the steps in the procedure will enable neurosurgeons to quickly learn the technique, or will inform general surgeons of what is required in combined operations.