The authors developed a method for retroperitoneal placement of a lumboperitoneal (LP) shunt with the aid of endoscopic monitoring. To perform this procedure, the patient is positioned laterally, the retroperitoneum is entered and dilated with a balloon through a small incision in the flank, and the space is maintained with CO2 insufflation. A peritoneal catheter is introduced into the cavity from the lumbar incision, through which the spinal catheter has been inserted. With the aid of a percutaneous nephroscope inserted in the cavity, the peritoneum is opened with endoscopically guided forceps through the manipulation channel. The shunt tube is then inserted into the pelvic peritoneum with the same forceps. Only two small skin incisions are needed for this method, and the shunt system is shorter compared with the conventional LP setup, which may lessen the risk of obstruction. This method is advantageous in patients who have undergone previous abdominal surgery, because it provides access to the peritoneum without concern for the presence of peritoneal adhesions.
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