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Technique of Intraperitoneal Chemotherapy: Normothermic and Hyperthermic 1303
AB
C MN, USA)
Figure 7. HIPEC Open ‘Coliseum’Technique.
From (44) with kind permission of the publisher and Dr Jesus Es- are elevated upwards by their attachment to the retractor.
quivel, St Agnes Hospital, Baltimore, MD, USA
incision in the anterior abdominal wall and 2-4 closed
suction drains are placed through the abdominal wall and
made watertight with a purse-string suture at the skin. A
temperature probe is secured to the skin edge. A long #2
monofilament suture is used to elevate the skin edges to
the arms of the self-retaining Thompson retractor which
is set up 4” above the incision and with the retractor
arms completely surrounding the incision. A strong
plastic sheet is incorporated into these sutures which will
Figure 6. Are reprinted from Esquivel J, Sugarbaker PH, Helm CW.
Techniques of delivering hyperthermic intraperitoneal chemother-
apy. In Helm CW, Edwards RP, eds. Intraperitoneal Cancer Therapy.
Totowa, NJ: Humana Press Inc. 2007: 163-177, with kind permission
of Springer Science and Business Media.
A. The skin edges are approximated carefully. B. Ready to perfuse.
The skin incision has been closed and the inflow and outflow tub-
ing connected to the perfusion pump. C. Example of a circulating
pump. This one is the HT-1000 (Thermasolutions Inc, White Plains,
completely cover the wound as the sides of the incision
Once this is completed, a slit in the plastic sheet is made
just sufficient to allow the surgeon’s double-gloved hand
access to the abdomen and pelvis. The perfusion is begun
as for the closed technique and the hand of the surgeon
gently helps distribute the perfusate throughout the cavity
continuously manipulating all viscera to keep adherence
of peritoneal surfaces to a minimum. If necessary the
sheet can be opened widely to allow surgery or sampling
to be performed during the perfusion.
Peritoneal Cavity Expander (PCE)
A technique popular in some Asian centers has been the
use of an ‘expander’ to increase the volume of the PC and
facilitate distribution of the perfusate (44). The expander
is a cylinder made of acrylic, which contains inflow, and
outflow catheters that are secured over the wound. The
cylinder fills with the perfusate as it is instilled into the PC
and the small bowel can float freely in this. Disadvantages
were reported by Elias (48) who found oozing around the
wound and tumor recurrences inside the parietal wound
which had not been treated due to the presence of the
expander.
Open or Closed: Which is the Best Method?
The open method has the advantage that there is more
complete distribution of the heat and chemotherapy