A Simple Laparoscopic Technique to Place the Abdominal Limb of Lumboperitoneal Shunts

Lumboperitoneal shunts (LPS) allow cerebrospinal fluid diversion in cases of communicating hydrocephalus. Placement of the abdominal limb of the catheter historically relied upon laparotomy, but more recently has been performed laparoscopically. Lateral decubitus positioning of the patient poses a challenge to the laparoscopic surgeon gaining access to the peritoneum.

A series of 22 patients undergoing 34 LPS procedures performed by a single surgeon from April 2009 to January 2025 was retrospectively analyzed. The catheter is tunneled towards the flank by the neurosurgical service with the patient in the lateral decubitus position. Veress needle is placed in the subcostal position and pneumoperitoneum is established. A 5-mm port is inserted through an ipsilateral midabdominal incision. Through a 10-French introducer sheath, the tubing is tunneled into the abdomen. Adequate flow of cerebrospinal fluid is observed.

Twenty-two patients with a mean age of 37 ± 7.3 years underwent 34 LPS procedures which included 22 primary LPS placements, 10 replacements, and 2 revisions. LPS indications were idiopathic intracranial hypertension (17), pseudo meningocele (2), and other diagnoses (3). All secondary procedures were performed due to dysfunction of the lumbar portion of the catheter. There were no cases of peritonitis, intra-abdominal infection, or hemorrhage.

We suggest a simple technique for laparoscopic peritoneal catheter placement during LPS insertion, which can be done with the patient in the lateral decubitus position utilizing a single port, and without mobilization of the colon.