A new laparoscopic method for implantation of peritoneal catheters

The placement of peritoneal catheters by non-surgeons was facilitated by a percutaneous laparoscopic technique ("Y-tec"). We have developed a catheter implantation system that is simpler to use, is less expensive initially and per procedure, and provides greatly enhanced peritoneal visualization. The core of the system is a 4 mm diameter Verres needle, which has a protective spring loaded obturator. This fits within a stainless steel cannula, which is in turn surrounded by a disposable peel away sheath. This entire unit is inserted into the peritoneal cavity through the rectus muscle after blunt dissection. Pneumoperitoneum is optional. The Verres needle is removed and peritoneoscopy is performed with a 5 mm Storz laparoscope. This is withdrawn, followed by the steel cannula, leaving the peel away sheath. The catheter is inserted through this, over a stylet. The sheath is then peeled off and the catheter sutured and tunneled in the usual fashion. This method uses the safest mode of blind peritoneal entry and permits thorough peritoneal inspection, even without insufflation. The needle and cannula are reusable, which minimizes cost. The technique is simple, and early results with inexperienced operators are encouraging.