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. 2008 Feb;15(2):542-6.
doi: 10.1245/s10434-007-9635-x. Epub 2007 Oct 10.

Closed hyperthermic intraperitoneal chemotherapy with open abdomen: a novel technique to reduce exposure of the surgical team to chemotherapy drugs

Laurent Benoit  1 , Nicolas Cheynel, Pablo Ortega-Deballon, Giovanni Di Giacomo, Bruno Chauffert, Patrick Rat
Affiliations

Closed hyperthermic intraperitoneal chemotherapy with open abdomen: a novel technique to reduce exposure of the surgical team to chemotherapy drugs

Laurent Benoit et al. Ann Surg Oncol. 2008 Feb.

Abstract

Background: Exposure of the surgical team to toxic drugs during hyperthermic intraperitoneal chemotherapy (HIPEC) remains a matter of great concern. During closed-abdomen HIPEC, operating room staff are not exposed to drugs, but the distribution of the heated liquid within the abdomen is not optimal. With open-abdomen HIPEC, the opposite is true. Although the open-abdomen method is potentially more effective, it has not become a standard procedure because of the risk of exposure of members of the team to drugs.

Methods: We present a new technique (closed HIPEC with open abdomen) which ensures protection against potentially contaminating exposure to liquids, vapours and aerosols, and allows permanent access to the whole abdominal cavity. Its principle is to extend the abdominal surgical wound upwards with a sort of "glove-box". The cutaneous edges of the laparotomy are stapled to a latex "wall expander". The expander is draped over a special L-section metal frame placed above the abdomen. A transparent cover containing a "hand-access" port, like those used in laparoscopic surgery, is fixed inside the frame.

Results: In 10 patients, this device proved to be hermetic for both liquids and vapours. Intra-abdominal temperature was maintained between 42 and 43 degrees C during most of the procedure. The whole abdominal cavity was accessible to the surgeon, allowing optimal exposure of all peritoneal surfaces.

Conclusion: This technique allows optimal HIPEC, while limiting the potential toxic effects for the surgical, medical and paramedical teams.

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Figures

Figure 1
Figure 1
A hole with the same shape size of the laparotomy is cut in a large sheet of latex with round extremities to avoid angles.The edges of the hole are hermetically fixed to the skin with staples (every 5mm).
Figure 2
Figure 2
A transparent cover containing a gel port in its middle is fixed on the frame sustained by the Thompson retractor. It closes hermetically the expanded abdominal cavity. Temperature probes, inflow and outflow pass through the latex sheet. Homogeneity of the temperature and the exposure of peritoneum in the abdomen is ensured by permanent stirring of the liquid and by repositioning the inflow catheter or tilting the operating table.
Figure 3
Figure 3
Transverse schema showing the expanded abdominal cavity during hyperthermic intraperitoneal chemotherapy.
See this image and copyright information in PMC

References

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