Peritoneal Dialysis Access: Open versus Laparoscopic Surgical Techniques

Hwang, Christine; Davidson, Ingemar; Santarelli, Stefano; Zeiler, Matthias; Ceraudo, E; Pedone, Meri; Saxena, Ramesh; Slakey, Douglas P.; Wade, Melissa; Gallieni, Maurizio

doi:10.5301/jva.5000174

Cited by 9 publications

(15 citation statements)

References 31 publications

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“…Strategies for uniform drug distribution include (i) design of the device as a long tube to maximize its reach within the peritoneal cavity and (ii) implantation of multiple smaller devices localized to different cavity quadrants. Fixation of the human device to the abdominal wall can prevent unwanted migration, similar to laparoscopic internal fixation of peritoneal dialysis catheters to the abdominal rectus muscle [29,30].…”

Section: Discussionmentioning

confidence: 99%

Sustained, low-dose intraperitoneal cisplatin improves treatment outcome in ovarian cancer mouse models

Tanenbaum

et al. 2015

Journal of Controlled Release

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Intraperitoneal (IP) chemotherapy for ovarian cancer treatment prolongs overall survival by 16 months compared to intravenous chemotherapy but is not widely practiced due to catheter-related complications and complexity of administration. An implantable, nonresorbable IP microdevice was used to release chemotherapeutic agent at a constant rate of approximately 1.3 µg/hour in vitro and 1.0 µg/hour in vivo. Studies conducted in two orthotopic murine models bearing human xenografts (SKOV3 and UCI101) demonstrate that continuous dosing reduces tumor burden to the same extent as weekly IP bolus drug injections. Treatment-induced toxicity was quantified via body weight loss and complete blood count. The microdevice resulted in significantly less toxicity than IP bolus injections, despite administration of higher cumulative doses (total area under the concentration-time curve of 3,049 ng-day/mL with the microdevice vs. 2,118 ng-day/mL with IP bolus injections). This preclinical study supports the concept that reduced toxicity with similar efficacy outcomes can be achieved by continuous dosing in ovarian cancer patients currently treated with IP therapy.

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Section: Discussionmentioning

confidence: 99%

Sustained, low-dose intraperitoneal cisplatin improves treatment outcome in ovarian cancer mouse models

Tanenbaum

et al. 2015

Journal of Controlled Release

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“…Previous abdominal surgeries, however, should not be absolute contraindications for PD. Some patients do develop peritoneal adhesion after abdominal surgeries, but the extent of adhesions is difficult to predict without laparoscopic exploration [31][32][33]. Direct visualization of the peritoneum and placement of PD catheter by advanced laparoscopy has been very successful in most instances [34,35].…”

Section: Patients Selectionmentioning

confidence: 99%

“…However, a recent meta-analysis comparing open dissection, basic laparoscopic, and advanced laparoscopic procedures demonstrated significantly superior outcomes for advanced laparoscopy over the other two approaches [58]. Quite likely, the advanced laparoscopic technique allows adjunctive procedures such as lysis of adhesions, omentopexy, identification and repair previously unsuspected hernias that can further improve catheter outcomes [32,59].…”

Section: Urgent Placement Of Pd Cathetersmentioning

confidence: 99%

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How To Build a Successful Urgent-Start Peritoneal Dialysis Program

Rajora

Shastri

Pirwani³

et al. 2020

Kidney360

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In-center hemodialysis (HD) remains the predominant dialysis therapy in patients with ESKD. Many patients with ESKD present in late stage, requiring urgent dialysis initiation, and the majority start HD with central venous catheters (CVCs), which are associated with poor outcomes and high cost of care. Peritoneal dialysis (PD) catheters can be safely placed in such patients with late-presenting ESKD, obviating the need for CVCs. PD can begin almost immediately in the recumbent position, using low fill volumes. Such PD initiations, commencing within 2 weeks of the catheter placement, are termed urgent-start PD (USPD). Most patients with an intact peritoneal cavity and stable home situation are eligible for USPD. Although there is a small risk of PD catheter–related mechanical complications, most can be managed conservatively. Moreover, overall outcomes of USPD are comparable to those with planned PD initiations, in contrast to the high rate of catheter-related infections and bacteremia associated with urgent-start HD. The ongoing coronavirus disease 2019 pandemic has further exposed the vulnerability of patients with ESKD getting in-center HD. PD can mitigate the risk of infection by reducing environmental exposure to the virus. Thus, USPD is a safe and cost-effective option for unplanned dialysis initiation in patients with late-presenting ESKD. To develop a successful USPD program, a strong infrastructure with clear pathways is essential. Coordination of care between nephrologists, surgeons or interventionalists, and hospital and PD center staff is imperative so that patient education, home visits, PD catheter placements, and urgent PD initiations are accomplished expeditiously. Implementation of urgent-start PD will help to increase PD use, reduce cost, and improve patient outcomes, and will be a step forward in fostering the goal set by the Advancing American Kidney Health initiative.

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“…Flanigan et al (5) found that there is a substantial variability in catheter outcomes between centers, and suggested that such variability is more closely correlated with operator and center characteristics than with catheter design. Catheter placement techniques can also influence outcomes (6).…”

Section: Introductionmentioning

confidence: 99%

Type of Peritoneal Dialysis Catheter and Outcomes

et al. 2015

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In peritoneal dialysis (PD), a well-functioning catheter is of great importance, because a dysfunctional catheter may be associated with incidence of peritonitis, efficiency of dialysis, and to the overall quality of treatment, representing one of the main barriers to optimal use of PD. When considering the relationship between PD catheter type and outcomes, we should keep in mind the different types of available PD catheters, those that are most commonly used in clinical practice, and the available head-to-head comparisons in the literature. The main differences in PD catheter design include the number of cuffs, the shape of subcutaneous tract (straight vs. swan neck), and the shape of intraperitoneal tract (straight vs. coiled). The availability of the best catheter design and materials, along with a skillful management of PD access, may have the greatest impact on long-term patient outcome on PD. It is now established that the use of straight catheters may improve outcomes and technique survival, but further advances in PD catheter technology can potentially improve technique survival. The self-locating PD catheter is a well established device that has not been fully studied and it may represent, based on the available observational evidence and on the clinical experience, an already existing technological advance deserving further studies.

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Peritoneal Dialysis Access: Open versus Laparoscopic Surgical Techniques

Cited by 9 publications

References 31 publications

Sustained, low-dose intraperitoneal cisplatin improves treatment outcome in ovarian cancer mouse models

Sustained, low-dose intraperitoneal cisplatin improves treatment outcome in ovarian cancer mouse models

How To Build a Successful Urgent-Start Peritoneal Dialysis Program

Type of Peritoneal Dialysis Catheter and Outcomes

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