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Technique of Intraperitoneal Chemotherapy: Normothermic and Hyperthermic 1297

AB

CD

Figure 4. Laparoscopic placement of IP port. Plastic port with 9.6F silicone pre-attached,
single lumen catheter. (Bard Access Systems, Inc Salt Lake City, UT, USA Reorder number:
0602660). With grateful acknowledgement to Arlan F. Fuller, Jr. MD, Winchester Hospital,
Winchester, MA, USA. A. After making an incision over the right costal margin and creating
the ‘pocket’ for the port the tunneling device has enabled the distal end of the catheter to
be brought out through a stab incision in the right iliac fossa. B. The dilator is passed over
the guide wire. C. The catheter is passed through the introducer sheath and gently pulled
into the peritoneal cavity with the help of a laparoscopic grasper. D. While the catheter is
pulled gently from within the peritoneal cavity the introducer sheath is peeled away. E. The
final position and length of the catheter are adjusted.

E

the abdominal cavity are made at the surgeon’s discretion. grasper from the opposite side of the abdomen while the
A direct entry approach using a 5mm laparoscopic port introducer sheath is removed (Figure 4C, D). The catheter
in the left upper quadrant is useful. An ancillary port position is then adjusted and trimmed to the right length
may be placed through the umbilicus or in the iliac fossa laparoscopically (Figure 4E). By surgeon preference, a
contralateral to the intended side of the IP chemotherapy securing 3/0 polyglactin 310 suture (Vicryl®; Ethicon, Inc
port. After visual inspection and adhesiolysis, as Somerville, NJ, USA) may be placed around the catheter
indicated, the IP chemotherapy port is sited over the at the peritoneal entry point.
costal margin (16).
To ensure that the catheter is not kinked or
A 5mm incision is made in the skin at the intended constricted in its final position the subcutaneous fascia
entry point for the catheter. The TD with catheter around the catheter adjacent to where it passes through
attached can be passed from the port site caudally deep to the external oblique fascia is opened up with forceps. A
Scarpa’s fascia and brought out through the 5mm incision modification of placing the port in the in the left lower
with the help of forceps (Figure 4A). The catheter length quadrant just superior and medial to the left iliac crest
is adjusted and the port can be sutured and secured to the has been reported (17).
fascia above the costal margin. The TD is detached and
the catheter directed into the PC either directly, using Port Complications
a Kelly forceps or, indirectly using the syringe, needle,
guide wire and dilator supplied in the venous access kit Complications involving peritoneal access ports are
(Figure 4B) (Personal Communication: Arlan F. Fuller, common, 6.8% to 40%, with 2.5 - 37% discontinuing IP
MD). The track of the catheter is dilated using the 10F chemotherapy as a result of port complications (15, 16,
dilator passed over the guide wire and the catheter is 18).
passed into the PC through the removable introducer
sheath. The catheter is grasped with a laparoscopic Table 3 shows a list of complications, approximate
frequency of occurrence and management. Since
port complications, including bowel and vaginal