Ventriculoperitoneal shunt (VPS) placement is an important therapeutic technique. Placement of the abdominal portion of VPS can be difficult in the setting of previous abdominal surgery, prior failure of VPS, or obesity. Even under ideal circumstances, standard mini-laparotomy does not allow precision in VPS positioning. We describe a single-port technique for VPS placement. While the neurosurgeon places a right frontal ventricular catheter and valve, an infraumbilical trocar is placed utilizing the open Hasson technique. A 12-mm operating laparoscope with an 8-mm channel is used to inspect the abdomen and identify the VPS entry site. Adhesions interfering with shunt placement can be lysed through the working channel of the laparoscope. Under laparoscopic visualization, an 18-gauge needle is introduced through a 5-mm incision in the right upper quadrant and the VPS tubing is tunneled to that site. A J-tipped guidewire is introduced, and the needle is exchanged for a dilator and peel-away sheath. The VPS is delivered through the sheath, which is sectioned and removed. An atraumatic grasper, placed through the laparoscope, directs the VPS to the desired intraabdominal location. Function of the VPS is assessed visually while compressing the valve. Suture closure of the trocar site and VPS entry site completes the procedure. We used this method successfully in a series of five patients with excellent outcome. A 14-month follow-up has revealed no failures or postoperative complications. This method is less invasive than mini-laparotomy, allows for precision placement of the abdominal portion of VPS, and confirms appropriate function.

Equipment Design↗

PubMed1998

Laparoscopic endobiliary stenting as an adjunct to common bile duct exploration.

BACKGROUND: The management of common bile duct stones (CBDS) in the era of operative laparoscopy is evolving. Several minimally invasive techniques to remove CBDS have been described, including preoperative endoscopic retrograde cholangiopancreatography (ERCP), postoperative ERCP, lithotripsy, laparoscopic transcystic common bile duct exploration, and laparoscopic choledochotomy with common bile duct exploration (CBDE). Because of the risks and limitations of these procedures, we utilize laparoscopically placed endobiliary stents as an adjunct to CBDE. METHODS: Sixteen patients underwent laparoscopic common bile duct exploration (LCBDE) by either choledochotomy or the transcystic technique with placement of endobiliary stents. These patients were identified during laparoscopic cholecystectomy as having occult choledocholithiasis, using routine dynamic intraoperative cholangiography. RESULTS: CBDS were successfully removed in all patients as demonstrated by completion cholangiography and intraoperative choledochoscopy. Eighty percent of patients were discharged the following day; the first three patients in this series were observed for 48 h prior to discharge. No patient required T-tube placement and closed suction drains were removed the morning after surgery. Stents were removed endoscopically at 1 month. Six- to 30-month follow-up demonstrates no complications to date. CONCLUSIONS: Laparoscopic endobiliary stenting reduces operative morbidity, eliminates the complications of T-tubes, and allows patients to return to unrestricted activity quickly. We recommend laparoscopically placed endobiliary stents in patients undergoing LCBDE.

Cholangiography↗

PubMed1992

A secure method for rapid placement of laparoscopic instruments.

Explore the source record for details and available documents.

Humans↗

PubMed1991

The role of streptokinase in treating complicated popliteal entrapment syndrome.

Explore the source record for details and available documents.

Adolescent↗

PubMed1991

A simple method for creating subcutaneous tunnels.

A trocar chest tube is an excellent tunneling device. It is readily available in a variety of sizes in all hospitals. It requires no special ordering and is inexpensive. The trocar chest tube glides through subcutaneous tissues easily, resulting in less trauma to the tissue compared with the forceful passage of poorly suited, large, blunt-tipped instruments. Operating room personnel are more likely to be familiar with the location of common trocar chest tubes than infrequently used commercial tunnelers. The option of creating curved tunnels when necessary broadens the applications of this disposable, easy to use instrument.

Adipose Tissue↗

PubMedDate not supplied

A simplified technique for percutaneous endoscopic gastrostomy.

Percutaneous endoscopic gastrostomy (PEG) is the preferred method of establishing long-term enteral access for feeding. Many patients requiring PEG are elderly and at risk for complications. Expeditious placement of the gastrostomy tube will minimize complications, but distorted esophageal anatomy can significantly lengthen the procedure. Some endoscopists abandon conventional repeat gastroscopy in difficult cases to accelerate the procedure. The authors describe a reliable method for quick reinsertion of the endoscope which shortens time required for PEG, and may reduce complications.

Enteral Nutrition↗

PubMedDate not supplied

Laparoscopic endobiliary stenting: a simplified approach to the management of occult common bile duct stones.

Three years ago we described laparoscopic placement of biliary stents as an adjunct to laparoscopic common bile duct exploration (LCBDE) in 16 patients. We now present a modification of our technique and experience with 48 additional patients. Laparoscopic cholecystectomy with intraoperative fluorocholangiography (LC/IOC) performed in 372 consecutive patients during a 36-month period revealed common bile duct stones (CBDS) in 48 patients (12.9%). In this series, LCBDE was not performed and no attempt was made to clear CBDS prior to transcystic stent placement. Stent placement added 9 to 26 minutes of operative time to LC/IOC alone. Forty-four patients (92%) were discharged after surgery and four (8%) were observed overnight. Outpatient endoscopic retrograde cholangiopancreatography 1 to 4 weeks later succeeded in clearing CBDS in all patients. All stents were retrieved without difficulty and 3- to 36-month follow-up demonstrates no surgical, endoscopic, or stent-related complications to date. Laparoscopic biliary stent placement for the treatment of CBDS is a safe, rapid, technically less challenging alternative to existing methods of LCBDE. It preserves the benefits of minimally invasive surgery for patients, and virtually assures success of postoperative endoscopic retrograde cholangiopancreatography with complete stone clearance.

Cholangiography↗