Background: Lumbar peritoneal and ventriculoperitoneal shunts are widely used for the treatment
of hydrocephalus. In the past, the abdominal portion of these procedures required laparotomy. With
the advent of minimally invasive techniques, laparoscopically assisted placement of the distal catheter
has been tried.
Materials and Methods: We performed 10 shunt procedures (3 lumbar peritoneal, 6 ventriculoperitoneal, and 1 meningomyelocele-peritoneal) in 10 patients (mean age 56; age range, 30–78 years).
Four patients had undergone previous open shunt placement that failed. The abdominal portion of
the procedure was performed using a 5-mm trocar and a 10Fr introducer for camera and catheter
insertion. In 3 cases, an additional 5-mm port was necessary for lysis of adhesions. These access
punctures did not require fascial closure and caused minimal pain and limitation.
Results: No intra- or postoperative complications were encountered in this small patient group.
At a median follow-up of 50 months (range, 3–56 months) all patients had functioning shunts.
Conclusion: Single trocar laparoscopically assisted placement of central nervous system–peritoneal shunts is safe and simple, and should be considered the procedure of choice. This technique
is also suitable for repositioning migrated catheters and other catheter-tip manipulations.
