Nephroscope-assisted single trocar peritoneal dialysis catheter insertion improves catheter survival compared with laparoscopic technique: Ten-year experience of a single-center

Han-Chung Yang; Hsiang-Chen Hsieh; Po-Chi Liao; Li-Wen Chang; Ju-Chuan Hu; Sheng-Chun Hung; Chia-Yen Lin; Shu-Chi Wang; Cheng-Che Chen; Cheng-Kuang Yang; Shian-Shiang Wang; Chuan-Shu Chen; Kevin Lu; Jian-Ri Li; Chen-Li Cheng; Kun-Yuan Chiu

doi:10.1016/j.asjsur.2023.08.143

Nephroscope-assisted single trocar peritoneal dialysis catheter insertion improves catheter survival compared with laparoscopic technique: Ten-year experience of a single-center

Asian J Surg. 2024 Jan;47(1):303-309. doi: 10.1016/j.asjsur.2023.08.143. Epub 2023 Sep 7.

Authors

Affiliations

¹ Department of Urology, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
² Department of Urology, Taichung Veterans General Hospital, Taichung, Taiwan.
³ Department of Urology, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
⁴ Department of Urology, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Medicine and Nursing, Hungkuang University, Taichung, Taiwan; Department of Applied Chemistry, National Chi Nan University, Nantou, Taiwan.
⁵ Department of Urology, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Institute of Biomedical Science, National Chung Hsing University, Taichung, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
⁶ Department of Urology, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medicine and Nursing, Hungkuang University, Taichung, Taiwan; Institute of Biomedical Science, National Chung Hsing University, Taichung, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
⁷ Department of Urology, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
⁸ Department of Urology, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Biomedical Science, National Chung Hsing University, Taichung, Taiwan; Department of Applied Chemistry, National Chi Nan University, Nantou, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan. Electronic address: kychiu37782002@gmail.com.

PMID: 37689515
DOI: 10.1016/j.asjsur.2023.08.143

Abstract

Background: An ideal technique for peritoneal dialysis (PD) catheter insertion should provide a long-term functioning catheter until permanent renal replacement therapy becomes available. We developed a technique using the nephroscope-assisted single-trocar approach in 2011. In this study, we report the outcomes, learning curve analysis and cost-effectiveness analysisof the nephroscopic approach compared with the traditional laparoscopic approach.

Method: Between January 2005 and December 2020, we retrospectively reviewed 511 patients who received PD catheter insertions using the laparoscopic or nephroscopic approach. We compared the baseline characteristics of the patients, surgical outcomes, and complications of the two groups. We further analyzed the nephroscopic group to determine the cost-effectiveness analysis, learning curve and the complication frequency between the learning and mastery periods of the nephroscopic approach.

Results: A total of 208 patients underwent laparoscopic PD catheter insertion, whereas 303 patients received nephroscopic surgery. The median catheter survival in the nephroscopic group is significantly longer (43.1 vs. 60.5 months, p = 0.019). The incidence of peritonitis (29.3% vs.20.8%, p = 0.035) and exit site infection (12.5% vs. 6.6%, p = 0.019) were significantly lower in the nephroscopic group. The cost-effectiveness analysis showed a medical expense reduction of 16000 USD annually by using the nephroscopic technique. There was no difference in the frequency of surgical complications between the learning and mastery phases when examining the learning curve analysis for the nephroscopic technique.

Conclusions: Compared with the traditional laparoscopic approach, the nephroscopic technique effectively prolonged catheter survival and reduces health care cost by reducing infectious complications. The low complication rate during the learning phase of surgery makes the procedure safe for patients and surgeons.

Keywords: Catheter infection; Catheter survival; Learning curve analysis; Nephroscope-assisted; Peritoneal dialysis catheter.

MeSH terms

Catheters, Indwelling
Humans
Kidney Failure, Chronic* / etiology
Kidney Failure, Chronic* / therapy
Laparoscopy* / methods
Peritoneal Dialysis* / methods
Retrospective Studies
Surgical Instruments