V. Kurbatov1, C. Ibarra1, R. Haywood1, P. S. Yoo1 1Yale University School Of Medicine,General Surgery,New Haven, CT, USA
Introduction:
Laparoscopic peritoneal dialysis catheter (PDC) insertion has been determined to be the optimal method for establishing access for peritoneal dialysis. The modality allows direct intra-abdominal visualization and extraperitoneal tunneling, making it ideal for patients with significant obesity or intraabdominal adhesions. Using a standardized and simplified surgical technique that eschews additional procedures such as omentopexy and extensive lysis of adhesions, we have developed a resident-led consulting service for laparoscopic peritoneal dialysis catheter insertion. Using a reproducible strategy, residents are trained to safely establish PDC access, ensure adequacy of function, and recognize and manage complications of PDCs.
Methods:
We performed a 5 year retrospective chart review of a single surgeon’s experience supervising the resident-led service, as part of the transplant surgery rotation at a quaternary academic medical center. Under the direct supervision of a single attending surgeon, trainees performed all aspects of pre-operative, operative, and post-operative care. Demographic and clinical data were collected to evaluate technical outcomes.
Results:
89 patients underwent laparoscopic primary placement of PDC. A 94.3% technical success rate at 60 days was achieved. 1-year and 2-year catheter technical success rates were 92.4% and 91.9%, respectively. 12.5% of patients required a repositioning procedure, obesity and history of previous surgery were more common in this group. Mean time to reposition was 224 days. 11.2% of patients underwent removal of PD catheter after renal transplantation.
Conclusion:
Our experience serves as a model for fostering surgical trainee expertise with laparoscopic peritoneal dialysis catheter insertion and management without sacrificing a high level of quality. Under the close supervision of an attending surgeon, clinical outcomes are comparable or superior to reported rates. Effective training of general surgery residents in laparoscopic peritoneal dialysis catheter insertion with standardized simplified technique is a key means to ensuring laparoscopic placement continues to be standard of care for peritoneal dialysis catheter placement.