Comparative outcomes of image-guided percutaneous catheterization versus direct visualization catheterization for peritoneal dialysis: A meta-analysis

Yi Li; Lifang Li; Meiju Wei; Yanxiong Qin; Yuechen Qin; Yue Zou; Haijian Zeng; Chunlan Li; Tingting Liao

doi:10.1371/journal.pone.0325600

Peer Review History

Original SubmissionNovember 11, 2024
Decision Letter - Wisit Kaewput, Editor Dear Dr. Liao, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Feb 16 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. 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Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols . We look forward to receiving your revised manuscript. Kind regards, Wisit Kaewput, MD Academic Editor PLOS ONE Journal requirements:-->--> -->-->When submitting your revision, we need you to address these additional requirements.-->--> -->-->1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at -->-->https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and -->-->https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf.-->--> -->-->2. As required by our policy on Data Availability, please ensure your manuscript or supplementary information includes the following: -->--> -->-->A numbered table of all studies identified in the literature search, including those that were excluded from the analyses.  -->--> -->-->For every excluded study, the table should list the reason(s) for exclusion.  -->--> -->-->If any of the included studies are unpublished, include a link (URL) to the primary source or detailed information about how the content can be accessed. -->--> -->-->A table of all data extracted from the primary research sources for the systematic review and/or meta-analysis. The table must include the following information for each study: -->--> -->-->Name of data extractors and date of data extraction -->--> -->-->Confirmation that the study was eligible to be included in the review.  -->--> -->-->All data extracted from each study for the reported systematic review and/or meta-analysis that would be needed to replicate your analyses. -->--> -->-->If data or supporting information were obtained from another source (e.g. correspondence with the author of the original research article), please provide the source of data and dates on which the data/information were obtained by your research group. -->--> -->-->If applicable for your analysis, a table showing the completed risk of bias and quality/certainty assessments for each study or outcome.  Please ensure this is provided for each domain or parameter assessed. For example, if you used the Cochrane risk-of-bias tool for randomized trials, provide answers to each of the signalling questions for each study. If you used GRADE to assess certainty of evidence, provide judgements about each of the quality of evidence factor. This should be provided for each outcome.  -->--> -->-->An explanation of how missing data were handled. -->--> -->--> -->-->This information can be included in the main text, supplementary information, or relevant data repository. Please note that providing these underlying data is a requirement for publication in this journal, and if these data are not provided your manuscript might be rejected.  -->--> -->-->3. We note that the grant information you provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections do not match. -->--> -->-->When you resubmit, please ensure that you provide the correct grant numbers for the awards you received for your study in the ‘Funding Information’ section.-->--> -->-->4. Thank you for stating the following financial disclosure: -->--> [copy in funding statement].  -->-->Please state what role the funders took in the study.  If the funders had no role, please state: ""The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."" -->-->If this statement is not correct you must amend it as needed. -->-->Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf.-->?> [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? Reviewer #1: Yes Reviewer #2: No Reviewer #3: Yes Reviewer #4: Yes Reviewer #5: Yes Reviewer #6: Yes Reviewer #7: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes Reviewer #4: Yes Reviewer #5: Yes Reviewer #6: Yes Reviewer #7: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes Reviewer #4: Yes Reviewer #5: Yes Reviewer #6: Yes Reviewer #7: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes Reviewer #4: Yes Reviewer #5: Yes Reviewer #6: Yes Reviewer #7: Yes ****** Reviewer #1: This is a useful study. It will be good if there was mention about technical details used for each method of inserted the PD catheter. Perhaps a review of complications of interventional methods and their management if addressed may be useful. Reviewer #2: Well written manuscript. Consider creating a separate section for limitations of the study and highlighting them for future studies. Also, add more updated references to the last decade 2014-2024. Thanks Reviewer #3: Review on a manuscript titled: Comparative outcomes of image-guided percutaneous catheterization versus direct visualization catheterization for peritoneal dialysis: a meta-analysis 1. Title okay and other preliminaries, a. Change word catheterisation to catheterization, visualisation to visualization b. Other parts are okay, but authors may consider direct visualization as one of the key words c. All keywords must be written in a uniform way d. Abstract is relevant to the study e. Conflict of interest and financial disclosure are declared 2. Introduction a. Generally, well written and argued and the problem is apparent and concise) b. Sentence 35 ( …. Rate of up to 100,000 per …..) need completion c. Sentences 72-73 need revision, word therefore require completion 3. Search strategy (2.5) line 113 words ‘findings will be resolved’ should be changed to ‘revolved’ 4. Analysis (2.6), well summarized, but generally difficult for non-scholars to understand, a more simplified language would make the section more understandable to most readers 5. Results (3), a. Lines 133-136 the description of the flow chart is not clear. The description articles were sieved from 970 to 620 is clear, however it is obscure thereafter. A clear picture of what was done from 620 to 11 should be added. It is noted however the flow chart is very clear on this. b. The rest of the result section appear well written 6. Discussion a. Generally, well written, but b. Paragraph one of the discussion parts appears a repetition of the introductory section than introducing the discussion c. The discussion is generally skewed towards literature review than discussing the interpretation, limitation and implication of study findings as proposed by PRISMA checklist, authors are advised to rewrite the discussion d. The discussion on blind insertion of the catheter in the last paragraph on infection complication of the discussion (230-232) is out of scope of this study. This review was on image guided peritoneal catheter insertion vs direct vision (laparoscopic and open). e. Discussion on mechanical complications lines 234-239 too on based on a topic which was reviewed in the current meta-analysis. Authors are advised to adhere to PRISMA checklist f. On the discussion on catheter removal line 252, there a typo (catheter ing) which need to be corrected, g. Line 262 words ‘markedly inferior to’ may be replaced by words ‘less frequent ..’ h. Line 263 last sentence ‘IGPC demonstrated the advantage of visualization, resulting in decreased rates of infection and mechanical problems’ is misleading and may not be originating from this review i. The study limitations at the end of the discussion 7. Conclusion a. Well written, but hidden within the discussion texts b. Conclusion is informed by review findings 8. Funding – declared as required, authors should be put word ‘and’ before the last sentence 9. References and attachments a. References are according to journal, but reference 17 may not be relevant b. All attachments are available Reviewer #4: In this study, the author conducted metaanalysis to comapre image-guided percutaneous insertion or surgical (open or laparoscopic) insertion of peritoneal dialysis catheter. They found image-guided percutaneous placement had lower rate of infectious and mechanical complications. catheter removal rate was low in percutaneous group as well. they concluded percutaneous insertion is a safe and effective procedure. The authors mixed open and laparoscopic procedure to a single group, but I wonder some comlication such as wound infection might be significantly different between laparoscopic and open surgery. What is the difference of this meta-analysis compared to previous one (DOI: 10.1177/20543581211052731) and what kind of new information is added? Because several meta-analysis have been published recently, I reccomend authors clarify why they permorm the same comparison. Why were some studies included previous metaanalysis (i.e. doi: 10.3747/pdi.2013.00003, DOI: 10.1007/s40620-020-00896-w) not included in this study? minor point line 133) Following the assessmentof the titles and abstracts, 19 articles were deemed inappropriate and subsequently excluded. Ultimately, we incorporated 11 pertinent articles. Number doesn't match the figure 1. probably 8 instead of 19? line 163, 185) Mechanical complications -> mechanical complications Reviewer #5: Dear Authors congratulation for your hard work and meta-analysis to compere the two common techniques for peritoneal dialysis and support the image-guided percutaneous catheterisation (IGPC) and direct visualization catheterisation(DVC) and conclude the superiority of IGPC for PD. thank you very much Reviewer #6: The authors present an interesting study looking at a meta analysis between image-guided PD catheter insertion vs. direct catheter insertion. The authors show that IGPD had lower infection rates, mechanical complications, and catheter removal. There was no difference noted in 1-year PD catheter survival between the 2 cohorts. The authors state that the articles included were most recently up to 7/16/24. However, the authors did not include when the earliest date of the studies included in this meta analysis was published and would be very helpful in interpreting these results. Obviously, over time, our perioperative infectious rates have improved with antibiotic and sterilization technique improvements. In addition, technological improvements in the development of PD catheters has also significantly improved since their inception. What are the credentials of the 2-3 investigators that performed this analysis? Do they hold professional degrees? Are they clinically oriented or purely research oriented personnel? Are the authors advocating that all PD catheters are inserted under image-guidance? What is the cost difference of utilizing image-guidance vs. direct insertion? This data would really help strengthen the authors' already strong argument. Did the direct visualization cohort include MIS and open tecniques? Was there any difference between direct visualization techniques themselves? A sub group analysis of differences between direct. visualization techniques would also help improve the impact of this study. Reviewer #7: Peritoneal dialysis (PD) is an importend treatment modality for end stage renal patients. The Paper is a meta-analysis looking at the optimal catheterisation method for peritoneal dialysis (PD), comparing the outcomes of image-guided percutaneous catheterisation (IGPC) versus direct visualisation catheterisation (DVC). It includes 11 studies from multiple countries, comprising a total of 8,981 patients, of which 2,518 patients received IGPC and 6,463 patients received DVC. The high number of patients originates from 1 American article with 7096 patients, while the others have much lower numbers. They looked at infectious complications, mechanical complications, one-year PD catheter survival, and catheter removal and found no significant disparity regarding one-year PD catheter survival between two groups. Nonetheless, IGPC significantly reduced the incidence of infectious complications, mechanical complications and catheter removal compared with DVC. The limitations are discussed. Comments: Table 1: Gender should also be written in percentages for easier comparison. It should be noted if single center or multicenter /or nationwide. BMI should be decided by group (IGPC/DVC) Cathetertype – it should be noted if it is a one or two- cuff catheter It should be noted in more detail how the procedures are done in each study, including a decription of how long the patient had to be in the hospital for the procedure. Cathter removal can also be due to the patient being transplanted, it is not addressed if this is included as a cause for removal The authors conclude it is safe to use IGPC and also that the infectious complications were reduced. In the largest of the included studies, they state that IGPC had had higher sepsis and mortality – this should be discussed. ****** what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy Reviewer #1: No Reviewer #2: Yes: Mahmoud Elfiky Reviewer #3: Yes: Masumbuko Y. Mwashambwa Reviewer #4: Yes: Katsuhiro Ito Reviewer #5: Yes: Abdullah Saeed Abdullah Reviewer #6: No Reviewer #7: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org . Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: PLOS ONE REVIEW.docx https://doi.org/10.1371/journal.pone.0325600.r002
Revision 1
17 Mar 2025 Author Response 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf. Response: We ensure that our manuscript meets PLOS ONE's style requirements. 2. As required by our policy on Data Availability, please ensure your manuscript or supplementary information includes the following: A numbered table of all studies identified in the literature search, including those that were excluded from the analyses. For every excluded study, the table should list the reason(s) for exclusion. If any of the included studies are unpublished, include a link (URL) to the primary source or detailed information about how the content can be accessed. A table of all data extracted from the primary research sources for the systematic review and/or meta-analysis. The table must include the following information for each study: Name of data extractors and date of data extraction Confirmation that the study was eligible to be included in the review. All data extracted from each study for the reported systematic review and/or meta-analysis that would be needed to replicate your analyses. If data or supporting information were obtained from another source (e.g. correspondence with the author of the original research article), please provide the source of data and dates on which the data/information were obtained by your research group. If applicable for your analysis, a table showing the completed risk of bias and quality/certainty assessments for each study or outcome. Please ensure this is provided for each domain or parameter assessed. For example, if you used the Cochrane risk-of-bias tool for randomized trials, provide answers to each of the signalling questions for each study. If you used GRADE to assess certainty of evidence, provide judgements about each of the quality of evidence factor. This should be provided for each outcome. An explanation of how missing data were handled. This information can be included in the main text, supplementary information, or relevant data repository. Please note that providing these underlying data is a requirement for publication in this journal, and if these data are not provided your manuscript might be rejected. Response: All of this information has been submitted within the main text and uploaded in the form of supplementary information. All studies obtained from literature searches: S 2 Checklist; A summary table of all data extracted from the main sources of research: S 4 Dataset; Bias risk and quality/certainty assessment: S 5 Dataset. 3. We note that the grant information you provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections do not match. When you resubmit, please ensure that you provide the correct grant numbers for the awards you received for your study in the ‘Funding Information’ section. Response: Thank you for the reminder. Upon reconfirmation, we have found that we have not received any financial support. The text has been modified accordingly. Please check the revised lines 340-341. 4.Thank you for stating the following financial disclosure: [copy in funding statement]. Please state what role the funders took in the study. If the funders had no role, please state: ""The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."" If this statement is not correct you must amend it as needed. Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf. Response: Thank you for your correction. We have added an amended Role of Funder statement to our cover letter. Please assist in updating the form submitted online. We also wish to add something: due to our negligence, we discovered that in the initial submission of information, we mistakenly wrote the corresponding author's information as "Guangxi Medical University First Affiliated Hospital: The First Affiliated Hospital of Guangxi Medical University" instead of "The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology". This was an error, and it has been corrected upon resubmission. Reviewer #1: This is a useful study. It will be good if there was mention about technical details used for each method of inserted the PD catheter. Perhaps a review of complications of interventional methods and their management if addressed may be useful. Response: Thank you for your affirmation of our research. Due to the excessive length, regarding the technical details of each PD catheter insertion and hospital stay, we have provided a table in S3 Text Supplementary Material 2. We reviewed the prevention and management of complications related to the interventional method in lines 255-266 of the text. Reviewer #2: Well written manuscript. Consider creating a separate section for limitations of the study and highlighting them for future studies. Also, add more updated references to the last decade 2014-2024. Thanks Response: Thank you for your suggestion. We have discussed the limitations of our study in lines 281-311 and updated with references added from the past decade. Reviewer #3: Review on a manuscript titled: Comparative outcomes of image-guided percutaneous catheterization versus direct visualization catheterization for peritoneal dialysis: a meta-analysis 1. Title okay and other preliminaries, a. Change word catheterisation to catheterization, visualisation to visualization b. Other parts are okay, but authors may consider direct visualization as one of the key words c. All keywords must be written in a uniform way d. Abstract is relevant to the study e. Conflict of interest and financial disclosure are declared Response: Regarding spelling errors: Thank you for your careful examination. We apologize for our carelessness. Based on your suggestions, we have made modifications to ensure the consistency of the vocabulary throughout the entire manuscript. 2. Introduction a. Generally, well written and argued and the problem is apparent and concise) b. Sentence 35 ( …. Rate of up to 100,000 per …..) need completion c. Sentences 72-73 need revision, word therefore require completion Response: Modified. 3. Search strategy (2.5) line 113 words ‘findings will be resolved’ should be changed to ‘revolved’ Response: Modified. 4. Analysis (2.6), well summarized, but generally difficult for non-scholars to understand, a more simplified language would make the section more understandable to most readers Response: Your consideration is meaningful, but it belongs to the operational basis in our research process, which has been written in a standardized manner and cannot be further simplified. 5. Results (3), a. Lines 133-136 the description of the flow chart is not clear. The description articles were sieved from 970 to 620 is clear, however it is obscure thereafter. A clear picture of what was done from 620 to 11 should be added. It is noted however the flow chart is very clear on this. b. The rest of the result section appear well written Response: We have supplemented and improved on lines 139-142. 6. Discussion a. Generally, well written, but b. Paragraph one of the discussion parts appears a repetition of the introductory section than introducing the discussion c. The discussion is generally skewed towards literature review than discussing the interpretation, limitation and implication of study findings as proposed by PRISMA checklist, authors are advised to rewrite the discussion d. The discussion on blind insertion of the catheter in the last paragraph on infection complication of the discussion (230-232) is out of scope of this study. This review was on image guided peritoneal catheter insertion vs direct vision (laparoscopic and open). e. Discussion on mechanical complications lines 234-239 too on based on a topic which was reviewed in the current meta-analysis. Authors are advised to adhere to PRISMA checklist f. On the discussion on catheter removal line 252, there a typo (catheter ing) which need to be corrected, g. Line 262 words ‘markedly inferior to’ may be replaced by words ‘less frequent ..’ h. Line 263 last sentence ‘IGPC demonstrated the advantage of visualization, resulting in decreased rates of infection and mechanical problems’ is misleading and may not be originating from this review i. The study limitations at the end of the discussion Response: Thank you for your feedback. After discussion, we have structured our discussion content into four subheadings based on the discussion section of the PRISMA checklist and have reorganized our discussion accordingly. Please refer to the revised lines 228-334. 7. Conclusion a. Well written, but hidden within the discussion texts b. Conclusion is informed by review findings Response: Modified. 8. Funding – declared as required, authors should be put word ‘and’ before the last sentence Response: Added. 9. References and attachments a. References are according to journal, but reference 17 may not be relevant b. All attachments are available Response: Thank you for promptly correcting our error, we have replaced the document, please refer to the revised lines 411-413. Reviewer #4: In this study, the author conducted metaanalysis to comapre image-guided percutaneous insertion or surgical (open or laparoscopic) insertion of peritoneal dialysis catheter. They found image-guided percutaneous placement had lower rate of infectious and mechanical complications. catheter removal rate was low in percutaneous group as well. they concluded percutaneous insertion is a safe and effective procedure. The authors mixed open and laparoscopic procedure to a single group, but I wonder some comlication such as wound infection might be significantly different between laparoscopic and open surgery. Response: Your consideration is necessary. We found in a CAPD I Trial (DOI: 10.3747/pdi.2017.00023) that compared the outcomes of open placement with laparoscopic placement of PD catheters, the experiment indicated that the clinical success rates of both techniques are the same. In another randomized controlled trial (https://doi.org/10.1186/s12882-020-01724-w), laparoscopic PD catheter insertion may be superior to conventional open catheter insertion, but its bleeding incidence (OR: 3.25, 95% CI: 1.18 to 8.97, P: 0.02) is higher than the open surgical catheter insertion technique. To further confirm our conclusion, we also conducted a subgroup analysis of each technique (advanced image-guided percutaneous puncture, laparoscopy, open surgery), and the results still showed that the IGPC group has potential advantages. However, this conclusion needs to be confirmed with further large-sample-size, multi-center, high-quality RCTs. What is the difference of this meta-analysis compared to previous one (DOI: 10.1177/20543581211052731) and what kind of new information is added? Because several meta-analysis have been published recently, I reccomend authors clarify why they permorm the same comparison. Why were some studies included previous metaanalysis (i.e. doi: 10.3747/pdi.2013.00003, DOI: 10.1007/s40620-020-00896-w) not included in this study? Response: In our study, it is explicitly required that the percutaneous group involves the placement of peritoneal dialysis catheters under the guidance of fluoroscopy or ultrasound. To our knowledge, this is also the first meta-analysis comparing image-guided percutaneous puncture techniques with direct visualization techniques. However, the inclusion criteria for Percutaneous Versus Surgical Insertion of Peritoneal Dialysis Catheters: A Systematic Review and Meta-Analysis (DOI: 10.1177/20543581211052731) did not exclude studies using blinding methods. Similarly, some studies included in previous meta-analyses (e.g., doi: 10.3747/pdi.2013.00003, DOI: 10.1007/s40620-020-00896-w) also included blinding in their percutaneous group, which does not meet our inclusion criteria. minor point line 133) Following the assessmentof the titles and abstracts, 19 articles were deemed inappropriate and subsequently excluded. Ultimately, we incorporated 11 pertinent articles. Number doesn't match the figure 1. probably 8 instead of 19? line 163, 185) Mechanical complications -> mechanical complications Response: Thank you for your correction, it has been modified. Reviewer #5: Dear Authors congratulation for your hard work and meta-analysis to compere the two common techniques for peritoneal dialysis and support the image-guided percutaneous catheterisation (IGPC) and direct visualization catheterisation(DVC) and conclude the superiority of IGPC for PD. thank you very much Response: Thank you for your affirmation. Reviewer #6: The authors present an interesting study looking at a meta analysis between image-guided PD catheter insertion vs. direct catheter insertion. The authors show that IGPD had lower infection rates, mechanical complications, and catheter removal. There was no difference noted in 1-year PD catheter survival between the 2 cohorts. The authors state that the articles included were most recently up to 7/16/24. However, the authors did not include when the earliest date of the studies included in this meta analysis was published and would be very helpful in interpreting these results. Obviously, over time, our perioperative infectious rates have improved with antibiotic and sterilization technique improvements. In addition, technological improvements in the development of PD catheters has also significantly improved since their inception. Response: Thank you for your question. Among us, one is a Doctor of Clinical Medicine, Associate Researcher; the other two are Bachelor of Clinical Medicine, Clinical Doctors. What are the credentials of the 2-3 investigators that performed this analysis? Do they hold professional degrees? Are they clinically oriented or purely research oriented personnel? Response: Thank you for your question. Among us, one is a Doctor of Clinical Medicine, Associate Researcher; the other two are Bachelor of Clinical Medicine, Clinical Doctors. Are the authors advocating that all PD catheters are inserted under image-guidance? Response: Although percutaneous catheter placement guided by imaging has its advantages, for those who require complex surgical interventions, such as hernia repair and adhesiolysis, surgical placement of PD catheters, whether laparoscopic or open, we believe should be the preferred surgical method. Overall, the decision on the placement of PD catheters should be individualized and made by a multidisciplinary team consisting of nephrologists, surgeons, interventional radiologists, and anesthesiologists. What is the cost difference of utilizing image-guidance vs. direct insertion? This data would really help strengthen the authors' already strong argument. Response: Thank you for your suggestion, we have consulted the relevant literature and discussed the matter on lines 313-319. Did the direct visualization cohort include MIS and open tecniques? Was there any difference between direct visualization techniques themselves? Response: Yes, the direct visualization queue includes MIS and open technologies, and their differences are discussed in the introduction section (please refer to the revised lines 56-63). A sub group analysis of differences between direct. visualization techniques would also help improve the impact of this study. Response: Thank you for your feedback, we have conducted subgroup analysis based on your suggestion (please refer to the revised lines 201-217). Reviewer #7: Peritoneal dialysis (PD) is an importend treatment modality for end stage renal patients. The Paper is a meta-analysis looking at the optimal catheterisation method for peritoneal dialysis (PD), comparing the outcomes of image-guided percutaneous catheterisation (IGPC) versus direct visualisation Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0325600.r003
Decision Letter - Wisit Kaewput, Editor Dear Dr. Liao, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Jun 18 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols . We look forward to receiving your revised manuscript. Kind regards, Wisit Kaewput, MD Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #1: All comments have been addressed Reviewer #2: All comments have been addressed Reviewer #4: All comments have been addressed Reviewer #6: (No Response) Reviewer #7: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #1: Yes Reviewer #2: Yes Reviewer #4: Yes Reviewer #6: (No Response) Reviewer #7: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes Reviewer #2: Yes Reviewer #4: Yes Reviewer #6: (No Response) Reviewer #7: N/A ****** 4. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes Reviewer #2: Yes Reviewer #4: Yes Reviewer #6: (No Response) Reviewer #7: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: Yes Reviewer #4: Yes Reviewer #6: (No Response) Reviewer #7: Yes ****** Reviewer #1: (No Response) Reviewer #2: Thank you for addressing all concerns. This study can be the pilot for more upcoming studies to address the issue Reviewer #4: (No Response) Reviewer #6: The authors have answered almost all of my comments. There is still one questions in which they have no addressed yet: "The authors state that the articles included were most recently up to 7/16/24. However, the authors did not include when the earliest date of the studies included in this meta analysis was published and would be very helpful in interpreting these results. Obviously, over time, our perioperative infectious rates have improved with antibiotic and sterilization technique improvements. In addition, technological improvements in the development of PD catheters has also significantly improved since their inception." I think inclusion of how early these studies have started will really help inform the reader about the outcomes seen in this study. Reviewer #7: Thank you for resubmitting this manuscript and addressing the comments from all reviewers. ****** what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy Reviewer #1: Yes: ashish jiwane Reviewer #2: Yes: Mahmoud Elfiky Reviewer #4: Yes: Katsuhiro Ito Reviewer #6: No Reviewer #7: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org https://doi.org/10.1371/journal.pone.0325600.r004
Revision 2
10 May 2025 Author Response If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Response: First of all, thank you for your suggestion. We have already registered the study protocol on PROSPERO (number CRD42024606795), so we do not intend to store the lab protocol in protocols.io anymore. Reviewer #6: The authors have answered almost all of my comments. There is still one question which they have not addressed yet: "The authors state that the articles included were most recently up to 7/16/24. However, the authors did not include when the earliest date of the studies included in this meta-analysis was published, which would be very helpful in interpreting these results. Obviously, over time, our perioperative infectious rates have improved with antibiotic and sterilisation technique improvements. In addition, technological improvements in the development of PD catheters have also significantly improved since their inception." I think inclusion of how early these studies have started will really help inform the reader about the outcomes seen in this study. Response: Thank you for the reminder that this was an oversight on our part. The issue has been modified in the original text, as detailed on pages 17, 82-83, and 143-144 of the revised text. Attachments Attachment Submitted filename: Response_to_Reviewers_auresp_2.docx https://doi.org/10.1371/journal.pone.0325600.r005
Decision Letter - Wisit Kaewput, Editor Comparative outcomes of image-guided percutaneous catheterization versus direct visualization catheterization for peritoneal dialysis: a meta-analysis PONE-D-24-51344R2 Dear Dr. Liao, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Wisit Kaewput, MD Academic Editor PLOS ONE Additional Editor Comments (optional): Accept as is. Reviewers' comments: https://doi.org/10.1371/journal.pone.0325600.r006
Formally Accepted
Acceptance Letter - Wisit Kaewput, Editor PONE-D-24-51344R2 PLOS ONE Dear Dr. Liao, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Wisit Kaewput Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0325600.r007

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