{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T14:19:47Z","timestamp":1793024387748,"version":"4.5.0"},"reference-count":43,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2011,7]]},"abstract":"\n Object<\/jats:title>\n Traditional ventriculoperitoneal (VP) shunt surgery involves insertion of the distal catheter by minilaparotomy. However, minilaparotomy may be a significant source of morbidity during shunt surgery. Laparoscopic insertion of the distal catheter is an alternative technique that may simplify and improve the safety of shunt surgery.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n The authors performed a retrospective review of hospital records of all patients undergoing new VP shunt insertion at a tertiary care center between 2004 and 2009. Patient characteristics and outcomes were compared between patients undergoing open or laparoscopic insertion of the distal catheter. Independent variables in the analysis included age, sex, race, body mass index, surgical technique, previous VP shunt placement, previous abdominal procedures, American Society of Anesthesiology (ASA) score, and indication for shunt placement. Dependent variables included the occurrence of shunt failure, cause of shunt failure, complications, length of stay (LOS), LOS after shunt placement, estimated blood loss, and operative time.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The authors identified 810 patients who met the inclusion criteria; open or laparoscopic distal catheter insertion was performed in 335 and 475 patients, respectively. There were no significant differences between the groups regarding age, race, ASA score, or indication for shunt placement. The most common indication was hydrocephalus due to subarachnoid hemorrhage, followed by tumor-associated hydrocephalus, normal pressure hydrocephalus (NPH), and hydrocephalus due to trauma. The incidence of shunt failure was not statistically different between cohorts, occurring in 20.0% of laparoscopic and 20.9% of open catheter placement cases (p = 0.791). With analysis of causes of shunt failure, shunt obstruction occurred significantly more often in the open surgery cohort (p = 0.012). In patients with a known cause shunt obstruction, distal obstruction occurred in 35.7% of the open cohort obstructions and 4.8% of the laparoscopic cohort obstructions (p = 0.014). The relative risk of distal obstruction in open cases compared with laparoscopic cases was 7.50. Infections occurred in 8.2% of laparoscopic cases compared with 6.6% of open cases (p = 0.419). Within the NPH subgroup, the laparoscopically treated patients had significantly more overdrainage (p = 0.040), whereas those in the open cohort experienced significantly more shunt obstructions (p = 0.034). Laparoscopically treated patients had shorter operative times (p < 0.0005), inpatient LOS (p < 0.001), and inpatient LOS after VP shunt placement (p = 0.01) as well as less blood loss (p = 0.058).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n To our knowledge this is the largest reported comparison of distal VP shunt catheter insertion techniques. Compared with minilaparotomy, the laparoscopic approach was associated with decreased time in the operating room and a decreased LOS. Moreover, laparoscopy was associated with fewer distal shunt obstructions. Laparoscopic shunt surgery is a viable alternative to traditional shunt surgery.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2011.1.jns101492","type":"journal-article","created":{"date-parts":[[2011,2,23]],"date-time":"2011-02-23T11:48:23Z","timestamp":1298461703000},"page":"151-158","source":"Crossref","is-referenced-by-count":82,"title":["Laparoscopic versus open insertion of the peritoneal catheter in ventriculoperitoneal shunt placement: review of 810 consecutive cases"],"prefix":"10.3171","volume":"115","author":[{"given":"Robert P.","family":"Naftel","sequence":"first","affiliation":[{"name":"Divisions of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua L.","family":"Argo","sequence":"additional","affiliation":[{"name":"General Surgery, Department of Surgery, University of Alabama;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chevis N.","family":"Shannon","sequence":"additional","affiliation":[{"name":"Divisions of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracy H.","family":"Taylor","sequence":"additional","affiliation":[{"name":"Divisions of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. Shane","family":"Tubbs","sequence":"additional","affiliation":[{"name":"Section of Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald H.","family":"Clements","sequence":"additional","affiliation":[{"name":"Division of General Surgery, Department of Surgery, Vanderbilt University, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark R.","family":"Harrigan","sequence":"additional","affiliation":[{"name":"Divisions of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns101492","series-title":"Radiology","first-page":"323","article-title":"Unusual abdominal complications of ventriculoperitoneal shunts","volume":"146","author":"Agha","year":"1983"},{"key":"b2-jns101492","series-title":"Surg Endosc","first-page":"1449","article-title":"Laparoscopic versus open approach for implantation of the peritoneal catheter during ventriculoperitoneal shunt placement","volume":"23","author":"Argo","year":"2009"},{"key":"b3-jns101492","series-title":"J Laparoendosc Surg","first-page":"191","article-title":"Laparoscopically assisted implantation of ventriculoperitoneal shunts","volume":"3","author":"Armbruster","year":"1993"},{"key":"b4-jns101492","series-title":"J Neurosurg","first-page":"869","article-title":"Minimally invasive implantation of the peritoneal catheter in ventriculoperitoneal shunt placement for hydrocephalus: analysis of data in 151 consecutive adult patients","volume":"105","author":"Bani","year":"2006"},{"key":"b5-jns101492","series-title":"Pediatr Neurosurg","first-page":"109","article-title":"Peritoneal catheter insertion using laparoscopic guidance","volume":"19","author":"Basauri","year":"1993"},{"key":"b6-jns101492","series-title":"Pediatr Neurosurg","first-page":"254","article-title":"Epidemiology of cerebrospinal fluid shunting","volume":"23","author":"Bondurant","year":"1995"},{"key":"b7-jns101492","series-title":"Am Surg","first-page":"50","article-title":"Abdominal complications of ventriculoperitoneal shunts. Case reports and review of the literature","volume":"54","author":"Bryant","year":"1988"},{"key":"b8-jns101492","series-title":"Neurosurgery","first-page":"E613","article-title":"Intra-abdominal vascular injury during trocar-assisted ventriculoperitoneal shunting: case report","volume":"63","author":"Danan","year":"2008"},{"key":"b9-jns101492","series-title":"Can J Neurol Sci","first-page":"123","article-title":"Epidemiology and direct economic impact of hydrocephalus: a community based study","volume":"25","author":"Del Bigio","year":"1998"},{"key":"b10-jns101492","series-title":"Pediatr Surg Int","first-page":"352","article-title":"The use of laparoscopy in the diagnosis and treatment of abdominal complications of ventriculo-peritoneal shunts in children","volume":"13","author":"Esposito","year":"1998"},{"key":"b11-jns101492","series-title":"Surg Endosc","first-page":"641","article-title":"Laparoscopic ventriculoperitoneal shunt placement: a single-trocar technique","volume":"14","author":"Fanelli","year":"2000"},{"key":"b12-jns101492","series-title":"J Laparoendosc Adv Surg Tech A","first-page":"1","article-title":"Single trocar laparoscopically assisted placement of central nervous system-peritoneal shunts","volume":"16","author":"Goitein","year":"2006"},{"key":"b13-jns101492","series-title":"Childs Nerv Syst","first-page":"77","article-title":"CSF shunt complications: an analysis of contributory factors","volume":"1","author":"Griebel","year":"1985"},{"key":"b14-jns101492","series-title":"Pediatrics","first-page":"791","article-title":"Intra-abdominal complications following ventriculoperitoneal shunt procedures","volume":"54","author":"Grosfeld","year":"1974"},{"key":"b15-jns101492","series-title":"J Neurosurg","first-page":"587","article-title":"Laparoscopic retrieval of disconnected ventriculoperitoneal shunt catheters. Report of four cases","volume":"56","author":"Guzinski","year":"1982"},{"key":"b16-jns101492","series-title":"J Neurosurg Pediatr","first-page":"282","article-title":"Laparoscopic placement of distal ventriculoperitoneal shunt catheters","volume":"2","author":"Handler","year":"2008"},{"key":"b17-jns101492","series-title":"Ann Surg","first-page":"821","article-title":"Impact of obesity on resource utilization for general surgical procedures","volume":"241","author":"Hawn","year":"2005"},{"issue":"6 Suppl","key":"b18-jns101492","series-title":"J Neurosurg","first-page":"421","article-title":"Laparoscopy-assisted ventriculoperitoneal shunt surgery in children: a series of 11 cases","volume":"106","author":"Jea","year":"2007"},{"key":"b19-jns101492","series-title":"Eur J Pediatr Surg","first-page":"79","article-title":"Laparoscopic-assisted placement of ventriculo-peritoneal shunt tips in children with multiple previous open abdominal ventriculo-peritoneal shunt surgeries","volume":"19","author":"Johnson","year":"2009"},{"key":"b20-jns101492","series-title":"Childs Nerv Syst","first-page":"524","article-title":"Timerelated patterns of ventricular shunt failure","volume":"10","author":"Kast","year":"1994"},{"key":"b21-jns101492","series-title":"J Neurosurg","first-page":"284","article-title":"Lack of benefit of endoscopic ventriculoperitoneal shunt insertion: a multicenter randomized trial","volume":"98","author":"Kestle","year":"2003"},{"key":"b22-jns101492","series-title":"Surg Endosc","first-page":"1007","article-title":"A laparoscopic approach to ventriculoperitoneal shunt placement in adults","volume":"13","author":"Khaitan","year":"1999"},{"key":"b23-jns101492","series-title":"Surg Neurol","first-page":"127","article-title":"Laparoscopic-assisted distal ventriculoperitoneal shunt placement","volume":"49","author":"Khosrovi","year":"1998"},{"key":"b24-jns101492","series-title":"Surg Laparosc Endosc Percutan Tech","first-page":"276","article-title":"Laparoscopically guided distal ventriculoperitoneal shunt placement","volume":"14","author":"Kirshtein","year":"2004"},{"key":"b25-jns101492","series-title":"Childs Nerv Syst","first-page":"271","article-title":"Multiple shunt failures: an analysis of relevant factors","volume":"14","author":"Lazareff","year":"1998"},{"key":"b26-jns101492","series-title":"Neurosurgery","first-page":"839","article-title":"Shunt failures and complications in adults as related to shunt type, diagnosis, and the experience of the surgeon","volume":"35","author":"Lund-Johansen","year":"1994"},{"key":"b27-jns101492","series-title":"Surg Endosc","first-page":"1866","article-title":"Laparoscopic management of distal ventriculoperitoneal shunt complications","volume":"22","author":"Nfonsam","year":"2008"},{"key":"b28-jns101492","series-title":"J Neurosurg Pediatr","first-page":"547","article-title":"Congenital hydrocephalus and ventriculoperitoneal shunts: influence of etiology and programmable shunts on revisions. Clinical article","volume":"4","author":"Notarianni","year":"2009"},{"key":"b29-jns101492","series-title":"J Neurosurg","first-page":"623","article-title":"Minimal-access technique for distal catheter insertion during ventricular peritoneal shunt procedures: a review of 100 cases. Technical note","volume":"111","author":"Ochalski","year":"2009"},{"key":"b30-jns101492","series-title":"Neurosurgery","first-page":"139","article-title":"Implanted ventricular shunts in the United States: the billion-dollar-a-year cost of hydrocephalus treatment","volume":"56","author":"Patwardhan","year":"2005"},{"key":"b31-jns101492","series-title":"Surg Neurol","first-page":"15","article-title":"The surgical treatment of hydrocephalus\u2014an historical review","volume":"15","author":"Pudenz","year":"1981"},{"key":"b32-jns101492","series-title":"J Urol","first-page":"295","article-title":"Abdominal and genitourinary complications following ventriculoperitoneal shunts","volume":"119","author":"Redman","year":"1978"},{"key":"b33-jns101492","series-title":"J Am Coll Surg","first-page":"637","article-title":"Ventriculoperitoneal shunt placement with video-laparoscopic guidance","volume":"187","author":"Reimer","year":"1998"},{"key":"b34-jns101492","series-title":"Surg Neurol","first-page":"177","article-title":"Laparoscopic versus nonlaparoscopic-assisted ventriculoperitoneal shunt placement in adults. A retrospective analysis","volume":"68","author":"Roth","year":"2007"},{"key":"b35-jns101492","series-title":"Mayo Clin Proc","first-page":"1064","article-title":"Laparoscopic placement of ventriculoperitoneal shunts: preliminary report","volume":"68","author":"Schievink","year":"1993"},{"key":"b36-jns101492","series-title":"Surg Endosc","first-page":"1588","article-title":"Laparoscopically assisted peritoneal shunt insertion in hydrocephalus: a prospective controlled study","volume":"19","author":"Schubert","year":"2005"},{"key":"b37-jns101492","series-title":"Br J Neurosurg","first-page":"439","article-title":"Laparoscopically assisted peritoneal shunt insertion for hydrocephalus","volume":"23","author":"Sekula","year":"2009"},{"key":"b38-jns101492","series-title":"Childs Nerv Syst","first-page":"797","article-title":"Laparoscopic retrieval of disconnected shunt catheters from the peritoneal cavity as a day-case procedure in children\u2014early feasibility report","volume":"26","author":"Short","year":"2010"},{"key":"b39-jns101492","series-title":"Surg Endosc","first-page":"253","article-title":"Adhesion formation with open versus laparoscopic cholecystectomy: an immunologic and histologic study","volume":"21","author":"Szab\u00f3","year":"2007"},{"key":"b40-jns101492","series-title":"J Neurosurg Pediatr","first-page":"402","article-title":"Distal revision of ventriculoperitoneal shunts using a peel-away sheath. Technical note","volume":"4","author":"Tubbs","year":"2009"},{"key":"b41-jns101492","series-title":"J Neurosurg","first-page":"31","article-title":"Risk factors for repeated cerebrospinal shunt failures in pediatric patients with hydrocephalus","volume":"92","author":"Tuli","year":"2000"},{"issue":"3 Suppl","key":"b42-jns101492","series-title":"Neurosurgery","first-page":"167","article-title":"Laparoscopic peritoneal catheter placement: results of a new method in 111 patients","volume":"61","author":"Turner","year":"2007"},{"key":"b43-jns101492","series-title":"JSLS","first-page":"122","article-title":"Laparoscopic guidance or revision of ventriculoperitoneal shunts in children","volume":"10","author":"Yu","year":"2006"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/115\/1\/article-p151.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/115\/1\/article-p151.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/115\/1\/article-p151.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,26]],"date-time":"2023-03-26T23:08:01Z","timestamp":1679872081000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/115\/1\/article-p151.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2011,7]]},"references-count":43,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.3171\/2011.1.jns101492","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,7]]}}}