PD cath placement
Date of Surgery -
Preop Diagnosis -
Postop Diagnosis -
Surgeon - Dr. Luk/Dr. Dan Tran
Assistant Surgeon -
Anesthesia -
Blood Loss - Minimal
Complication - None
Findings -
Specimens -
Indication-
Procedure Performed- Laparoscopic PD catheter placement
The patient has end-staged renal failure. The patient requires dialysis now starting his dialysis. A PD catheterization is requested for home peritoneal dialysis catheter.
The proposed procedure was discussed with the patient along with alternatives. All risks and benefits were explained to the patient and he/she agreed to the procedure.
DESCRIPTION OF PROCEDURE:
The patient was given preop antibiotics, brought to the OR, and placed supine on OR table. Patient was prepped and draped using standard prep. A 10 mm incision was created in the upper midline using a #11 scalpel. Dissection down to the fascia was performed using the S retractor. The fascia was opened and a 12 mm trocar was placed into the abdominal cavity. Next, the CO2 gas was used to insufflate the abdominal cavity. Next, evaluation of abdominal cavity was carried out. The anatomy was appropriate for placement of the catheter.
Next, on the right paramedian location, I made a 5 mm incision, where a trocar was placed. The trocar was allowed to dissect longitudinally along the posterior aspect of the rectus muscle to about 4-6 inches before the trocars allowed to puncture the posterior fascia. This way, a tunnel was created.
Finally, the PD catheter was placed into the abdominal cavity.
It was grasped using a grasper and pulled out along the tunnel that was created. The catheter has 2 cuffs. One cuff was positioned above the posterior rectus fascia and the other one in the subcutaneous space.
We injected saline into the catheter to make sure it flowed well.
Once we were satisfied with the inside part of the procedure, we removed the trocars, we released the CO2 gas. We closed the umbilical fascia using a 0 Prolene suture. We created a small tunnel to allow the catheter to be imbedded subcutaneously beneath the skin.
At the end of the case, counts were carried out. Instrument, sponge, and needle counts were completed and reported to me as correct.
Finally, we closed all incisions. We flushed the catheter with heparin aided saline. The patient overall tolerated the procedure well and transferred to recovery room in stable and satisfactory condition.