Laparoscopic Placement of the BardPort Intraperitoneal Catheter and Reservoir

Dr. Arlan F. Fuller, Jr.Gillette Center for Women's OncologyMassachusetts General Hospital

Choice of Catheter and Reservoir is the IV Device

Titanium Port with 9.6F attached catheter

Pre-placement ProcedurePerform laparoscopy in the usual manner with umbilical placement of laparoscope trocar and survey of the abdominal cavity for adhesionsPlace a 5 mm operative trocar in a position contralateral to the side of proposed catheter placementIdentify the prospective site in the lower quadrant for entry of the catheter into the peritoneal cavity

Mark the site for reservoir placement above the right costal margin

Incise the skin and develop a pocket for the reservoir

Incise the skin and develop a pocket for the reservoir

Check that the reservoir fits snugly into the pocket

Place the tunneler on the end of the catheter and start the passage deep to Scarpas fascia

Place a 5 mm transverse incision at the target site

Bluntly with a hemostat extend the incision beneath Scarpas fascia to contact the tunneler

Pass the tunneler out through the target incision

Pass the tunneler out through the target incision

Pass the catheter through the tunnel and the target incision and cut catheter to remove tunneler

Suture the reservoir in place to fascia and confirm catheter function

Place introducer needle through target incision adjacent to catheter

Visualize needle tip at the target site in the peritoneal cavity

Pass the guidewire with J tip through the introducer needle

Pass the guidewire with J tip through the introducer needle

Visualize J tip of the wire at the target site in the peritoneal cavity

Withdraw the introducer needle leaving the guidewire in place

Insert the introducer with the 10F dilator over the guidewire into the peritoneal cavity

Visualize the dilator AND the peel-away introducer in the peritoneal cavityDilatorDilatorIntroducer

Withdraw both the wire and the dilator from the introducer

Pass the catheter through the introducer and assist laparoscopically in advancing the catheter into the peritoneal cavity

Peel away the introducer while holding the catheter in the peritoneal cavity

Advance all the remaining catheter into the peritoneal cavity

Adjust position of catheter tip and confirm function by injectionLast, subcuticular closure of all incisions