The success of peritoneal dialysis (PD) depends on securing a functional, safe, and durable peritoneal access. Over recent decades, important advances in catheter design and insertion techniques have been consolidated, with the Tenckhoff catheter remaining the most widely used. Nevertheless, the prevalence of PD in Brazil remains limited, hindered by technical and logistical barriers to catheter placement, as well as by delays between indication and procedure. This review critically examines the main approaches to establishing PD access, with emphasis on technical aspects, clinical outcomes, and complications. Conventional surgery provides direct visualization of the peritoneal cavity in a simple and safe manner, whereas percutaneous methods, particularly those guided by ultrasonography and fluoroscopy, shorten hospitalization and broaden applicability when performed by nephrologists. Comparative evidence shows that percutaneous approaches achieve low rates of infectious and mechanical complications, with satisfactory catheter survival, while videolaparoscopic placement appears to yield superior results among the most frequently adopted techniques, despite greater technical and logistical complexity. Study heterogeneity limits definitive conclusions, underscoring the need for robust randomized clinical trials. Systematic use of imaging guidance may improve technical accuracy, while the active involvement of nephrologists in the procedure is crucial for reducing delays, optimizing outcomes, and expanding PD utilization. Standardization of practices and wider adoption of minimally invasive techniques represent promising avenues for strengthening PD as a therapeutic modality.
Chula et al. (Mon,) studied this question.