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Technique of Intraperitoneal Chemotherapy: Normothermic and Hyperthermic 1295

In the two studies that have reported comparative incision is made in the mid-clavicular line just cranial
outcomes for fenestrated versus single lumen catheters to the costal margin. In thin patients consider placing
there was no difference in overall complications or the the port just caudal to the costal margin. If the patient
percentage of patients in whom IP chemotherapy was has a preference for sleeping on a particular side, use the
discontinued because of the port (13, 14). These studies contralateral side. Dissection is taken down to the deep
did not compare cuffed versus cuff less ports and so this fascia overlying the costal margin and a ‘pocket’ just
issue remains open. Regardless of this concern, cuffed sufficient to accommodate the port is fashioned. Sutures
ports are more difficult to remove at the completion of such as 2/0 polypropylene (Prolene®; Ethicon, Inc.,
treatment because they become securely adherent to the Somerville, NJ, USA) are inserted to secure the port to
tissues of the abdominal wall. The bottom line is that the fascia appropriate to the final position of the port and
there are a wide variety of makes and types of ports that left untied while the catheter is situated (Figure 2A). The
can be used for IP chemotherapy delivery. Examples of tip of a tunneling device (TD) attached to the catheter is
some ports are listed in Table 1 and Figure 1A, B, C. passed either, from the PC cephalad to the port site, or
vice versa (Figure 2B, C). Whichever direction is used,
Port Placement the TD passes in the subcutaneous fat deep to Scarpa’s
A) At the Time of Cytoreductive Surgery fascia, the point of entry to the PC is approximately 5cms
Following cytoreductive surgery (CRS) the skin over lateral to the umbilicus, and the TD passes either, directly
the right or left costal margin is prepared and a 3-4 cm through the rectus sheath, muscle and peritoneum, or in

AB

C D

Figure 2. Intraperitoneal port placement at laparotomy: Titanium port
with 9.6F silicone catheter, un-attached, single lumen, no cuff. (Bard Ac-
cess Systems, Inc Salt Lake City, UT, USA) Reorder number: 0602870. Fig
2B and 2C reprinted from Esquivel J, Sugarbaker PH, Helm CW. Techniques
of delivering hyperthermic intraperitoneal chemotherapy. In Helm CW, Ed-
wards RP, eds. Intraperitoneal Cancer Therapy. Totowa, NJ: Humana Press
Inc. 2007: 163-177, with kind permission of Springer Science and Business
Media. A. The port is secured to the underlying fascia above the right cos-
tal margin with non-absorbable sutures. B. The tunneling device is guided
up through the subcutaneous tissues into the port pocket. C. The catheter
has been attached to the port and the distal end lies in the peritoneal cav-
ity. D. The position and appearance of the healed port placement incision
over the right costal margin.