Traditional insertion of a ventriculoperitoneal shunt (VPS) involves a small laparotomy incision. In addition to significant postoperative discomfort, abdominal portion of the procedure affects hospital stay and convalescence. Laparotomy incision may also contribute to wound/shunt infections and incisional hernias. We have utilized laparoscopy for the abdominal portion of VPS placement in attempts to minimize the shortcomings of the traditional method.

This video details all nuances of our technique for the laparoscopic-assisted VPS placement in the elderly female with normal pressure drocephalus. Our operating room set-up, patient positioning, incision locations, and laparoscopic trocar strategy are demonstrated. Both cranial and abdominal portions of the procedure are shown and discussed.

The total duration of the operation was 45 minutes. The blood loss was <50 cc and there were no perioperative complications. The patient required no narcotic analgesics post-operatively and remained in the hospital for 23 hour observation period only. She was fully ambulatory by 48 hours postoperatively, with rapid overall improvement of her neurologic symptoms.

The use of laparoscopy during VPS placement appears to be safe and effective. The benefits of this minimally invasive approach include minimal perioperative pain, short hospitalization, fast functional recovery, and decreased risk of wound/shunt infection and ventral incisional herniations.