Safety and Feasibility of a Newly Designed Single-Port Trocar for Laparoscopy-Assisted Ventriculoperitoneal Shunt Surgery : A Prospective Pilot Study

Objective: This study was conducted to investigate the safety and feasibility of a newly designed single-port trocar that allows peritoneal catheter placement without the need for additional abdominal puncture during laparoscopy-assisted ventriculoperitoneal shunt surgery. Methods: This prospective, single-arm pilot study included patients who underwent ventriculoperitoneal shunt surgery using a newly designed trocar system between March and December 2024. The new trocar features a lateral opening, a transparent body, and builtin gas insufflation capability, enabling both laparoscopic visualization and final catheter placement through a single port. Its design allows the entire trocar to be removed along with the catheter without disrupting its position. Demographic and operative data of patients were collected, and the primary outcomes were procedural feasibility and intraoperative safety. Institutional review board approval was obtained before study initiation. Results: This study enrolled 16 patients (median age, 63.5 years [interquartile range (IQR), 58-72]; median body mass index, 23.6 kg/m2 [IQR, 21.8-25.1]). The most common diagnosis was posttraumatic hydrocephalus (87.5%), followed by posthemorrhagic hydrocephalus. The incision length for trocar insertion was a median of 1.2 cm (IQR, 0.95-1.5). The trocar insertion time varied (median, 40.5 seconds [IQR, 19.5-61]). The total operative time (from skin incision to closure) was a median of 52.5 minutes (IQR, 50-60). Importantly, there were no intraoperative technical difficulties or trocar-related adverse events. No early postoperative complications related to trocar insertion or distal catheter placement were observed. One patient was readmitted with fever, which was subsequently attributed to pneumonia and was not related to the surgical procedure. Conclusion: This pilot study demonstrates the safety and feasibility of the newly designed trocar system for laparoscopy-assisted ventriculoperitoneal shunt surgery.