Laparoscopic HIPEC: A bridge between open and closed-techniques

Abstract

Hyperthermic intraperitoneal chemotherapy (HIPEC) is currently delivered after cytoreductive surgery in patients with several kinds of peritoneal surface malignancies. Different methods for delivering HIPEC have been proposed all of them being variations between two modalities: the open technique and the closed technique. The open technique assures optimal distribution of heat and cytotoxic solution, with the disadvantage of heat loss and leakage of cytotoxic drugs. The closed technique prevents heat loss and drug spillage, increases drug penetration, but does not warrant homogeneous distribution of the perfusion fluid. A novel procedure that combines the advantages of the two techniques by means of laparoscopy is herein presented.

Keywords: Cytoreductive surgery; HIPEC; hyperthermic intraperitoneal chemotherapy; peritoneal carcinomatosis; peritoneal surface malignancy.

Figure 1

Placement of drains, intra-abdominal pressure catheter, and thermal probes

Figure 2

Placement of the balloon trocars

Figure 3

Connections of HIPEC inflow line, CO₂ tube, and smoke aspirator

Figure 4

Intra-abdominal pressure values according to Stevin's law

Figure 5

A view of the perfusion fluid inflow

Figure 6

Stirring the abdominal contents with the palpators

Figure 7

Driving the perfusion fluid over the liver

Figure 8

Accessing the hepatorenal space

Figure 9

Air aspiration from a floating drain