A Novel Hybrid Technique for Peritoneal Dialysis Catheter Insertion

Background: Peritoneal Dialysis (PD) is an essential treatment for end-stage kidney disease (ESKD). Existing methods for PD catheter insertion have various limitations. This study introduces a novel hybrid method that combines laparoscopic and Seldinger techniques for PD catheter insertion. Methods: This retrospective study analyzed 320 patients undergoing their first PD catheter insertion, 23% of whom had a history of abdominal surgery. The cohort had two groups of patients: 170 patients received the traditional laparoscopic method, while 150 underwent the new hybrid method. Surgical outcomes, early and late complication rates, hospital stay duration, and medical expenses were compared between the two groups. Results: No significant differences were observed in baseline demographics and comorbidities between the groups. The hybrid method had in a significantly shorter break-in period (within 24 hours) and eliminated the need for temporary hemodialysis. Patients in the hybrid group had shorter hospital stays (1 week less) and lower medical expenses (saving $3000 USD) compared to those in the laparoscopic group (all p<0.05). The incidence of early complications was lower in the hybrid group, while late complication rates were comparable between the groups. Conclusion: The hybrid method is a safe and effective alternative for PD catheter insertion, especially for patients with previous abdominal surgeries or at risk of abdominal adhesions. It enables urgent-start PD, reduces hospital stays, and lowers medical costs, supporting its adoption as the new standard of care for ESKD patients requiring PD catheter insertion.Summary of different PD catheter implantation techniques - Open surgery Laparoscope Seldinger technique Novel Hybrid method Operator Surgeon/Physician Surgeon Physician Surgeon Anthesis General anthesis General Anthesis Local Anthesis General Anthesis Tissue manipulation Most More Minimal Minimal Direct visualization No Yes No Yes Break-in time 14 days 14 days 1 day 1 day Suitable for patients with previous abdominal surgery No Yes No Yes