Background
Key to successful peritoneal dialysis (PD) is the presence of a well-functioning PD catheter. Several complications, such as in- and outflow obstruction, peritonitis, exit-site infections, leakage and migration, can lead to catheter removal and loss of peritoneal access. The type of insertion technique used may greatly influence the occurrence of complications, however, a well- designed RCT is lacking.

Material and Methods
This multicenter RCT was designed as a pilot-study, because sufficient data to power was lacking. All patients eligible for PD between 2011 and 2014 were included and electronically allocated and randomized between laparoscopic versus open PD catheter insertion. Follow-up was 6 months. Several outcome measures were analyzed, as well as quality of life and postoperative X-rays to assess catheter position.

Results
Fifty-one patients were included. Twenty-five patients underwent open catheter insertion and twenty-six laparoscopic insertion. No significant differences in PD catheter survival at 6 weeks were found. Skin-to-skin operation time was significantly different in favor of the laparoscopic technique with a median of 25 minutes compared to 32 minutes in the open technique (p = 0.01). No difference was seen in catheter survival and quality of life at 6 months.

Conclusion
Although little difference was found between groups, the reduction of 22% in operation time using the laparoscopic technique may be clinically relevant and positively affect cost- effectiveness of the technique. A powered RCT is recommended to investigate whether the laparoscopic method is more cost-effective.