Laparoscopic insertion of ventriculoperitoneal shunts by neurosurgeons: An audit of a tertiary hospital practice.

OBJECTIVE

Since 2013, at the Royal Brisbane and Women's Hospital (RBWH) some neurosurgeons have routinely used laparoscopy to insert the distal catheter during ventriculoperitoneal shunt surgery. The purpose of this study was to investigate the safety and outcomes of laparoscopic ventriculoperitoneal shunt insertion by neurosurgeons, compared with laparoscopic shunt insertion by general surgeons and traditional, open, minilaparotomy by neurosurgeons or general surgeons.

METHODS

A retrospective audit was performed of all shunt surgery performed at RBWH over 9 years, collecting data from hospital and statewide electronic medical records and information systems.

RESULTS

Of 1078 shunt operations, there were 546 during which the peritoneal catheter of a ventriculoperitoneal shunt was inserted or revised. Neurosurgeons alone performed 151 laparoscopic shunt operations, general surgeons performed 72 laparoscopic operations, neurosurgeons performed 307 open shunt operations and general surgeons performed 16 open shunt procedures. Patients undergoing laparoscopic shunt insertion had a significantly lower risk of re-operation for malposition of the distal tubing (0 % vs 4 %, p < 0.05). After laparoscopic insertion by neurosurgeons there were fewer overall complications at 6 weeks (13 %) compared to those operated on by general surgeons (28 %) or open (21 %), but this was not significant on multivariate analysis. There was no significant difference between laparoscopic surgery by neurosurgeons, laparoscopic surgery by general surgeons or open surgery by neurosurgeons for infection (1.4%, 5.7%, 3.8%), distal obstruction (1.4%, 2.9%, 1.7%) or proximal complications (4.1%, 7.1%, 3.1%).On multivariate analysis, revision surgery was associated with increased distal complications, emergency surgery was associated with increased revision rate, programmable valves with reduced distal obstruction and antibiotic impregnated catheters with reduced infection. Laparoscopic surgery took ∼10 min longer in theatre on average. Patients admitted for shunt surgery alone had shorter length of stay after laparoscopic surgery (3.8 days) than open surgery (5.5 days, p = 0.02).

CONCLUSIONS

In selected patients, it is safe for neurosurgeons to use laparoscopy for ventriculoperitoneal shunt insertion without involvement of a general surgeon. Laparoscopic surgery may also have other benefits for the patient.