Videolaparoscopic peritoneal dialysis catheter implant and rescue procedures under local anesthesia with nitrous oxide pneumoperitoneum

Videolaparoscopic techniques are an increasingly used modality for peritoneal dialysis catheter implant and rescue procedures. The greatest impediment for acceptance of the laparoscopic approach has been the necessity of general anesthesia because peritoneal insufflation of CO2 gas produces pain. In addition, complications of CO2 pneumoperitoneum include hypercarbia, acidosis, and cardiac arrhythmias. Renal failure patients commonly have severe coexisting medical conditions that make them an unacceptable risk for both general anesthesia and CO2 peritoneal insufflation. From December 1996 through November 1997, laparoscopy was performed utilizing nitrous oxide (N2O) as the insufflation gas. Since N2O produces neither pain nor metabolic effects, the laparoscopic procedure was safely performed under local anesthesia. Thirty-one patients have had laparoscopic implantation of peritoneal dialysis catheters under local anesthesia with 22 procedures performed on an ambulatory basis. The remaining cases were already hospitalized for complications of their renal failure. Four laparoscopic rescue procedures for catheter dysfunction were performed under local anesthesia with 3 cases as outpatients. Surgical laparoscopy under local anesthesia with N2O insufflation is a safe approach for both implantation procedures and salvaging of malfunctioning catheters. The procedure can be performed on an outpatient basis, frequently without delay in initiation or interruption of peritoneal dialysis.