**5. Methods**

Fourteen consecutive hydrocephalic patients were treated with neuronavigated laparoscopically assisted VP shunts to explore the benefits offered by this surgical technique. Patient charts were collected retrospectively from February 2017 to March 2019. Collected charts were analyzed to obtain sex, age, BMI, indication for surgery, and whether the patient had a prior shunt placement or previous abdominal surgeries. Additionally, to assess the advantages of the neuronavigated laparoscopically assisted technique the variables collected were length of stay in hospital after surgery, operative time, intra- and post-operative complications, infection, and whether the shunt failed. No patients were excluded from this study. All surgeries were performed at the same institution by the same neurosurgeon and general surgeon. Clinical and radiological follow-up is done at 6-weeks post-operatively. The shunt series is used to evaluate the position of the shunt system and a brain CT is done to rule out over drainage (**Figure 1**).

The shunt series X-rays includes skull with an antero-posterior and lateral view, an antero-posterior chest x-ray and an antero-posterior abdominal x-ray.

The abdominal x-ray is repeated at 60 minutes to evaluate the peritoneal part of the shunt and its mobility (**Figure 2**).

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**Figure 2.**

*and programmable valve.*

**Figure 1.**

*ventricule.*

*Neuronavigated and Laparoscopic-Assisted Ventriculoperitoneal Shunt Placement*

*Pre (left) and post (right) operative brain Ct scan with ventricular catheter in the body of the right lateral* 

*Top Abdominal X-ray at day 1 (left) and at 3 months follow up (right) showing good peritoneal catheter mobility. Bottom Lateral skull X-ray (left) and Antero-posterior view (right) showing the ventricular catheter* 

*DOI: http://dx.doi.org/10.5772/intechopen.89252*

*Neuronavigated and Laparoscopic-Assisted Ventriculoperitoneal Shunt Placement DOI: http://dx.doi.org/10.5772/intechopen.89252*

**Figure 1.**

*New Insight into Cerebrovascular Diseases - An Updated Comprehensive Review*

The incision may be altered due to previous surgery and concern for adhesions. Generally, we will go through old incisions using the supra-umbilical technique, but an infra-umbilical or epigastric open technique can be used as well. The fascia is elevated between two Kocher instruments and divided with scalpel blade. The peritoneum is divided between two snap instruments with scalpel blade. A finger is inserted into the abdomen to ensure adhesions are clear of the undersurface of the abdominal wall. Previous surgery and/or adhesions are not a contra-indication to this technique. Adhesions may be taken down carefully from the undersurface of the abdominal wall to allow placement of the laparoscopic balloon port. A 5–10 mm laparoscopic balloon port is placed intra-abdominally and the abdomen insufflated. We maintain medium flow (20–30 L/min) and pressures (15 mmHg) for all cases. A 5 mm, 30-degree camera is inserted into the abdomen and used to visualize the undersurface of the abdominal wall. Placement of the catheter was generally in the RUQ but was also placed in left upper quadrant (LUQ ) depending on adhesions from previous surgeries or due to the presence of previously placed shunts. At times we did navigate through heavy adhesions to guide the catheter placement but did not ever need to take down adhesions laparoscopically or add additional trocars for

After the laparoscopic approach to the peritoneum is done, we approach the abdomen by a puncture using an introducer sheath and dilator (Arrow®). The catheter and CSF flow is observed in the peritoneal cavity. Once the shunt is placed the sheath is removed and skin closed with 4-0 subcuticular monocryl stitch. After final satisfactory inspection of the abdomen is desufflated and the camera and laparoscopic balloon port removed. Fascia is closed with a purse-string 0-PDS suture. Skin is closed with a 4-0 subcuticular monocryl stitch. Incisions are infiltrated with 0.5% Marcaine with epinephrine. Steristrips and dry dressings are

Following the completion of the laparoscopic portion of the procedure, the scalp

Fourteen consecutive hydrocephalic patients were treated with neuronavigated laparoscopically assisted VP shunts to explore the benefits offered by this surgical technique. Patient charts were collected retrospectively from February 2017 to March 2019. Collected charts were analyzed to obtain sex, age, BMI, indication for surgery, and whether the patient had a prior shunt placement or previous abdominal surgeries. Additionally, to assess the advantages of the neuronavigated laparoscopically assisted technique the variables collected were length of stay in hospital after surgery, operative time, intra- and post-operative complications, infection, and whether the shunt failed. No patients were excluded from this study. All surgeries were performed at the same institution by the same neurosurgeon and general surgeon. Clinical and radiological follow-up is done at 6-weeks post-operatively. The shunt series is used to evaluate the position of the shunt system and a brain CT

The shunt series X-rays includes skull with an antero-posterior and lateral view,

The abdominal x-ray is repeated at 60 minutes to evaluate the peritoneal part of

an antero-posterior chest x-ray and an antero-posterior abdominal x-ray.

closure is done in 2 layers and the entry point to the abdomen is closed in 1 layer. Patient is awakened extubated and transferred to recovery room. Once fully awake, patient is transferred to the floor; diet is started at 6 hours post operatively

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the catheter placement.

in addition to increasing activity.

is done to rule out over drainage (**Figure 1**).

the shunt and its mobility (**Figure 2**).

applied.

**5. Methods**

*Pre (left) and post (right) operative brain Ct scan with ventricular catheter in the body of the right lateral ventricule.*

#### **Figure 2.**

*Top Abdominal X-ray at day 1 (left) and at 3 months follow up (right) showing good peritoneal catheter mobility. Bottom Lateral skull X-ray (left) and Antero-posterior view (right) showing the ventricular catheter and programmable valve.*
