Use of Blunt Scalp Hooks for Abdominal Procedure in Lumboperitoneal Shunt Placement: Technical Note

Abstract

In obese patients, we often find difficulty in laparotomy for placing a lumboperitoneal shunt catheter. The authors introduced an easy technique to get a sufficiently wide and shallow operative field through small abdominal incision in obese people. Four blunt scalp hooks and rubber bands, commonly used in craniotomy, were prepared. The fat layer and the rectus abdominis muscle layer were retracted and pulled up using these hooks. Blunt scalp hooks were useful for safe and effective retraction of abdominal wall, which made a sufficient and shallow operative field.

Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus (Third Edition): Endorsed by the Japanese Society of Normal Pressure Hydrocephalus

“… 255 – 256) Besides, to prevent the tube from protruding out of the abdominal cavity, it is necessary to perform an insertion technique that eliminates all spaces through which the tube can potentially protrude or migrate under the skin. 8 , 257) …”

Lumboperitoneal shunt surgery via lateral abdominal laparotomy

“…7,16 This procedure requires that surgeons change the patient's position or tilt the operating bed, and these maneuvers are especially necessary in obese patients, because the abdominal fat around the umbilicus is difficult to control in the lateral decubitus position. 9,16 These cumbersome steps prolong the operation. Lateral abdominal wall laparotomy has several advantages over anterior abdominal laparotomy: it can be performed with the patient in the lateral position, and never requires either a position change or bed tilting.…”

“…To insert the spinal catheter into the subarachnoid lumbar space, LPS is usually peformed with the patient in the lateral decubitus position. 7,9,16 However, laparotomy around the periumbilical region in the lateral decubitus position can be quite difficult. 9,16 Therefore, based on a combination of factors, changing the patient's position and/or tilting the operating bed to a significant degree is required in most cases.…”

“…7,9,16 However, laparotomy around the periumbilical region in the lateral decubitus position can be quite difficult. 9,16 Therefore, based on a combination of factors, changing the patient's position and/or tilting the operating bed to a significant degree is required in most cases. 7,16 These cumbersome maneuvers are especially necessary in obese patients, and possibly a reason for surgeons choosing VPS surgery rather than LPS surgery.…”

“…Few reports have described the abdominal procedure for an LPS in great detail. 5,9 Thus, in this paper we introduce an LPS method via lateral abdominal laparotomy. We aimed to analyze our method in terms of technical features and outcomes.…”