Minimally invasive ‘pull technique’ for peritoneal dialysis catheter removal

2020 ◽  
pp. 089686082091502 ◽  
Author(s):  
Jian Wang ◽  
Xiao-Sheng Li ◽  
Feng-Xia Zhang ◽  
Run-Xiu Wang ◽  
Feng Cao ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Minimally Invasive ◽  
Tensile Force ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Noninvasive Method ◽  
Silicone Tube ◽  
Invasive Method ◽  
The Mean

A simple, noninvasive method for removing peritoneal dialysis (PD) catheters, called the “pull technique,” has become popular in recent years. Physicians still worry, however, about the range of its application and possible complications such as infection of the retained cuff and breakage. We, therefore, applied this technique in patients and enriched its administration for removing PD catheters. Altogether, 24 PD catheter removals in 24 patients were reviewed during the period from July 2018 to October 2019 in our hospital. Using the pull technique, the PD catheter’s superficial cuff was dissected using an electronic knife, and the deep cuff was retained. All patients’ catheters were successfully removed with no breakage. No incision or retained cuff was infected during the follow-up period (1.1–15.6 months). The appropriate peak force of pull traction was approximately 12–13 pounds, not very different from the mean maximum tensile force of 21.48 pounds for silicone tube breakage. The use of intermittent (rather than sustained) traction may reduce the breakage risk of the silicone tube. This method is a safe, practical, minimally invasive method for removing PD catheters, and it is suitable for application on special patients with peritonitis or who are on an immunosuppressant.

scholarly journals P1220COMPARISON OF PERITONEAL DIALYSIS CATHETER INSERTION TECHNIQUES BY NEPHROLOGISTS: SURGICAL METHOD VS BLIND METHOD USING A TROCAR

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Seok Hui Kang ◽  
Jong Won Park ◽  
Kyu Hynag Cho ◽  
Jun Young Do
Keyword(s):  
Peritoneal Dialysis ◽  
Survival Rates ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Patient Death ◽  
Surgical Method ◽  
Surgical Methods ◽  
Significant Difference ◽  
Insertion Techniques

Abstract Background and Aims Successful PD requires timely peritoneal dialysis catheter (PDC) insertion and management of PDC related complications. Some societies have recently made an effort to increase PD and PDC insertion by nephrologists is an important issue. The aim of the present study was to evaluate comparative analysis of PDC insertion between blind and surgical methods by nephrologists. Method We reviewed medical records at a tertiary medical center in Korea and identified 249 adults who underwent first-time PDC insertion. All PDC insertions were performed using the blind or surgical methods. In our hospital during study period, two of three nephrologists performed the blind method routinely in all of eligible patients (blind group, n = 144). One of three nephrologists performed the surgical method in all of eligible patients (surgical group, n = 105). During follow-up, we collected data regarding peritoneal dialysis peritonitis (PDP), exit site and/or tunnel infection (ESI/TI). Catheter survivor was defined as maintaining of PD at July 2019 or PDC removal by PDC unrelated problems such as patient death due to PDC unrelated factors, kidney transplantation, patient demand, inadequate PD, improved renal function, poor oral intake due to abdominal distension, and colon cancer. Catheter non-survivor and/or PDC associated removal was defined as PDC removal by PDC related problems such as PDP, ESI/TI or PDC malfunction. Intervention-free non-survivor was defined as PDC revision, removal, or exchange by PDC related problems. Results Mean age at the PDC insertion in blind and surgical groups were 57.5 ± 13.7 and 56.3 ± 12.9 years, respectively (P = 0.640). There were no significant differences in age, sex, body mass index, underlying disease of ESRD, and Davies comorbidity index between the 2 groups. Mean follow-up durations were 37.0 ± 26.3 and 32.6 ± 23.4 months in the blind and surgical groups, respectively (P = 0.172). Total numbers of patients with one or more PDP events during follow-up period were 72 (50.0%) and 42 (40.0%) in blind and surgical groups (P = 0.118). Total numbers of PDP episodes were 157 and 100, respectively. Total numbers of patients with one or more ESI/TI events during follow-up period were 14 (9.7%) and 7 (6.7%) in blind and surgical groups (P = 0.392). Total numbers of ESI/TI episodes were 27 and 8, respectively. The 5-year PDC survival rates were 87.0% and 91.1% in the blind and surgical groups, respectively (P = 0.995, Figure 1). The 5-year intervention-free survival rates were 79.6% and 77.0% in the blind and surgical groups, respectively (P = 0.723). The leading cause of PDC removal was patient death. There was no significant difference in the distributions of cause of PDC removal in the 2 groups (P = 0.335). PDC associated removal rates in blind and surgical groups were 14 (18.4%) and 9 (16.4%), respectively (P = 0.760). Conclusion Our study shows that catheter outcomes including infectious and mechanical complications and catheter survival are similar between blind and surgical insertion techniques by nephrologists.

scholarly journals Results and Lessons Learned on Robotic Assisted Kidney Transplantation

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Mireia Musquera ◽  
Lluis Peri ◽  
Tarek Ajami ◽  
Ignacio Revuelta ◽  
Laura Izquierdo ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Minimally Invasive ◽  
Late Complications ◽  
Lessons Learned ◽  
Ureteral Stenosis ◽  
Robotic Assisted ◽  
Conversion To Open Surgery ◽  
Invasive Method ◽  
The Mean

Introduction. Nowadays, minimally invasive surgery in kidney transplantation is a reality thanks to robotic assistance. In this paper, we describe our experience, how we developed the robotic assisted Kidney transplantation (RAKT) technique, and analyze our results. Material and Methods. This is a retrospective study of all RAKTs performed at our center between July 2015 and March 2020. We describe the donor selection, surgical technique, and analyze the surgical results and complications. A comparison between the first 20 cases and the following ones is performed. Results. During the aforementioned period, 82 living donor RAKTs were performed. The mean age was 47.4±13.4 and 50 (61%) were male. Mean body mass index was 25±4.7 and preemptive in 63.7% of cases. Right kidneys and multiple arteries were seen in 14.6% and 12.2%, respectively. Mean operative and rewarming time was 197±42 and 47±9.6 minutes, respectively. Five cases required conversion to open surgery because of abnormal kidney vascularization. Two patients required embolization for subcapsular and hypogastric artery bleeding without repercussion. Three kidneys were lost, two of them due to acute rejection and one because venous thrombosis. Late complications requiring surgery included one kidney artery stenosis, one ureteral stenosis, two lymphoceles, and three hernia repairs. We noticed a significant reduction in time between the first 20 cases and the following ones from 248.25±38.1 to 189.75±25.3 (p<0.05). With a mean follow-up time of 1.8 years (SD 1.3), the mean creatinine was 1.52 (SD 0.7) and RAKT graft survival was 98%. Conclusions. The robotic approach is an attractive, minimally invasive method for kidney transplantation, yielding good results. Further studies are needed to consider it a standard approach.

scholarly journals Preperitoneal Tunneling – a Novel Technique in Peritoneal Dialysis Catheter Insertion

2014 ◽  
Vol 34 (4) ◽  
pp. 443-446 ◽  
Author(s):  
Mohammad-Hadi Saeed Modaghegh ◽  
Gholamhossein Kazemzadeh ◽  
Yaser Rajabnejad ◽  
Fatemeh Nazemian
Keyword(s):  
Peritoneal Dialysis ◽  
Kidney Transplantation ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Safe Method ◽  
Catheter Survival ◽  
Catheter Migration ◽  
Novel Technique ◽  
Omental Wrapping

IntroductionThis study describes a new preperitoneal tunneling (PPT) method for inserting a peritoneal dialysis catheter (PDC), thereby lessening surgical complications and increasing the catheter's survival.MethodsThis new technique was used in 23 cases from December 2005 to January 2007 and followed up until March 2011 (63 months). The procedure was performed laparoscopically under local (16 cases) or general (7 cases) anesthesia by one surgeon. Catheter survival is reported by Kaplan-Meyer analysis.ResultsThe catheters were mechanically obstructed in 2/23 cases (8.7%); and were withdrawn due to a peritonitis in 2 cases and inadequacy of peritoneal dialysis in 1 case. Ten patients received kidney transplantation and six died before completing this follow-up period. The patients still reaped the benefits of the PDC until receiving a kidney transplant or death. The 5-year survival rate of the catheter was 89%. No incidence of catheter migration, omental wrapping, herniation or leakage was noticed.ConclusionPreperitoneal tunneling is a simple and safe method for insertion of PDC, and can effectively prevent catheter migration, dislocation and omental wrapping.

scholarly journals Minimally invasive fluoroscopic percutaneous peritoneal dialysis catheter salvage

2014 ◽  
Vol 7 (3) ◽  
pp. 264-268
Author(s):  
R. Narayan ◽  
T. Fried ◽  
G. Chica ◽  
M. Schaefer ◽  
D. Mullins
Keyword(s):  
Peritoneal Dialysis ◽  
Minimally Invasive ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter

A Novel Minimally Invasive Technique for Insertion of Peritoneal Dialysis Catheter

2002 ◽  
Vol 12 (4) ◽  
pp. 252-254 ◽  
Author(s):  
Aydin Dalgic ◽  
Emin Ersoy ◽  
Michael E. Anderson ◽  
Jonathan Lewis ◽  
Atilla Engin ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Minimally Invasive ◽  
Minimally Invasive Technique ◽  
Invasive Technique ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter

Outcomes of Peritoneal Dialysis Catheter Left in Place after Kidney Transplantation

2017 ◽  
Vol 37 (6) ◽  
pp. 651-654 ◽  
Author(s):  
Saúl Pampa-Saico ◽  
Fernando Caravaca-Fontán ◽  
Víctor Burguera-Vion ◽  
Víctor Diéz Nicolás ◽  
Estefanía Yerovi-León ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Kidney Transplantation ◽  
Graft Function ◽  
Optimal Time ◽  
Complication Rates ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Exit Site ◽  
Exit Site Infection

No clear consensus has been reached regarding the optimal time to remove the peritoneal dialysis catheter (PDC) after kidney transplantation (KT). This retrospective observational study, conducted in a single peritoneal dialysis (PD) unit including all PD patients who received a KT between 1995 - 2015, was undertaken to evaluate the clinical outcomes and potential complications associated with a PDC left in place after KT. Of the 132 PD patients who received a KT, 20 were excluded from the study. Of the remaining, 112 (85%) patients with functioning KT were discharged with their PDC left in place and had it removed in a mean interval of 5 ± 3 months after KT, after achieving optimal graft function. During this follow-up period, 7 patients (6%) developed exit-site infection and there were 2 cases (2%) of peritonitis; all of them were successfully treated. Delayed PDC removal after KT is associated with low complication rates, although regular examination is needed so that mild infections can be detected early and therapy promptly instituted.

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