Hyperthermic chemotherapy intra-abdominal laparoscopic approach: development of a laparoscopic model using CO 2 recirculation system and clinical translation in peritoneal carcinomatosis Susana S anchez-Garc ıa, David Padilla-Valverde, Pedro Villarejo-Campos, Esther P. Garc ıa-Santos and Jes us Mart ın-Fern andez Department of General Surgery, University General Hospital, Medicine School, University of Castilla la Mancha, Ciudad Real, Spain ABSTRACT Introduction: Hyperthermic intraperitoneal chemotherapy (HIPEC) is an effective treatment for peritoneal carcinomatosis (PC). Laparoscopic surgery is performed in the treatment of colorectal and appendiceal cancer, and PC from diverse origin in selected patients. HIPEC management by laparoscopic approach after cytoreductive surgery (CRS) completed locoregional treatment of PC, and may be feasible and safe after appropriate patient selection. Objective: Development of an experimental model of HIPEC by laparoscopic approach, with CO 2 recirculation. Clinical translation in two patients with PC and low peritoneal cancer index. Material and methods: We performed CRS in a porcine model of 5 pigs (35-38 kg) by laparoscopic approach. Laparoscopic HIPEC by CO 2 recirculation system was performed; laparoscopic access was used for catheter input and output placement (Paclitaxel 175 mg/m 2 for 60 min at 42 C). The experimental variables were: blood gases, haemodynamic and intra-abdominal and central temperature. Clinical model application was performed in three cases with PC from colorectal origin. Results: No statistically significant differences was found in blood gases, haemodynamic or temperature in the experimental study. In clinical study, there were no technical complications during laparoscopic-HIPEC approach, and we observed no changes in haemodynamic variables during the procedure. Conclusions: CRS and HIPEC laparoscopic model by CO 2 recirculation system is safe and feasible technique in selected patients, that include low PC index, local and accessible tumour recurrences or high-risk of PC tumours.
When discarded medical history as a cause of pneumoperitoneum, it is considered that ventilation is the most common cause. Benign idiopathic or nonsurgical pneumoperitoneum, can be be treated conservatively if the patient agrees. But if intraabdominal hypertension prevails, it can result in severe respiratory and hemodynamic deterioration, sometimes requiring abdominal decompression to immediately get lower abdominal pressure and thus improve hemodynamic function.
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