They tunnel it in the subq until the abdomen then they make a tiny incision in the peritoneum and depending on the neurosurgeon may have general surgery take a look laparoscopically to make sure there’s CSF flow then use the grasper to try to toss it in the right pericolic gutter over the liver.
Yeah sterile technique has to be meticulous in shunt cases. There’s evidence that the number of people scrubbed into the case influences the shunt infection rate so students like me occasionally would not be permitted to scrub.