Related Experiment Video
Updated: Apr 4, 2026
Laparoscopic-Assisted Seldinger Technique for Peritoneal Dialysis Catheter Insertion
Published on: May 23, 2025
Comparison of peritoneal dialysis catheter placement outcomes: image-guided percutaneous technique versus advanced
Ali Poyan Mehr1, Alvina Sundang2, Todd Drasin1
1Kaiser Permanente Northern California, 1 Kaiser Plaza, Oakland, United States.
Background:
Peritoneal dialysis (PD) is an increasingly emphasized modality in nephrology care, due to patient autonomy, reduced healthcare cost and alignment with value-based care initiatives. A critical factor influencing successful PD uptake is the timely placement of peritoneal dialysis catheters (PDCs). Traditional advanced laparoscopic surgical (ALS) methods are effective but constrained by the need for general anesthesia and operating room access. The image-guided percutaneous (IGP) approach has emerged as a potentially safer and more accessible alternative.
Methods:
We conducted a retrospective study of adult patients who underwent PDC placement within Kaiser Permanente Northern California (KPNC) from 1 January 2018 to 31 December 2022. Patient characteristics, procedural variables, post-procedure length of stay, 90- and 180-day catheter intervention rates, 30-day readmission and mortality rates were compared between IGP and ALS techniques.
Results:
Among 3062 patients, 835 (27%) received PDCs via IGP and 2227 (73%) via ALS. While there were differences in patient characteristics due to selection biases, with the IGP group having higher prevalence of heart failure, and lower body mass index (BMI), estimated glomerular filtration rate, hemoglobin and albumin levels, IGP was associated with significantly shorter post-procedure length of stay among admitted outpatients (1.8 vs 3.1 days, P = .01) and lower catheter intervention rates at 90 days (1% vs 2.5%, P = .006) and 180 days (1.3% vs 4%, P < .0001). After adjustment for patient gender, race, BMI and polycystic kidney disease status, the ALS technique remained significantly associated with higher odds of catheter re-intervention compared with IGP at both 90 days [adjusted odds ratio (OR) 2.76, 95% confidence interval (CI) 1.30-5.85, P = .008] and 180 days (adjusted OR 3.16, 95% CI 1.67-5.96, P < .0004). Overweight BMI was independently associated with increased intervention risk.
Conclusions:
Despite being applied to a potentially sicker patient cohort, IGP was associated with favorable short- and intermediate-term outcomes compared with ALS, including reduced catheter interventions, without compromising safety outcomes.
