Port-Site Metastases and Chimney Effect of B-Ultrasound-Guided and Laparoscopically-Assisted Hyperthermic Intraperitoneal Perfusion Chemotherapy

Abstract

PurposeCO2 leakage along the trocar (chimney effect) has been proposed to be an important factor underlying port-site metastasis after laparoscopic surgery. This study aimed to test this hypothesis by comparing the incidence of port-site metastasis between B-ultrasound-guided and laparoscopically-assisted hyperthermic intraperitoneal perfusion chemotherapy (HIPPC).Materials and MethodsSixty-two patients with malignant ascites induced by gastrointestinal or ovarian cancer were divided into two groups to receive either B-ultrasound-guided or laparoscopically-assisted HIPPC. Clinical efficacy was assessed from the objective remission rate (ORR), the Karnofsky Performance Status (KPS) score, and overall survival. The incidence of port-site metastasis was compared between the two groups.ResultsPatients in the B-ultrasound (n=32) and laparoscopy (n=30) groups were comparable in terms of age, sex, primary disease type, volume of ascites, and free cancer cell (FCC)-positive ascites. After HIPPC, there were no significant differences between the B-ultrasound and laparoscopy groups in the KPS score change, ORR, and median survival time. The incidence of port-site metastasis after HIPPC was not significantly different between the B-ultrasound (3 of 32, 9.36%) and laparoscopy (3 of 30, 10%) groups, but significantly different among pancreatic, gastric, ovarian, and colorectal cancer (33.33, 15.79, 10.00, and 0.00%, p<0.001).ConclusionThe chimney effect may not be the key reason for port-site metastasis after laparoscopy. Other factors may play a role, including the local microenvironment at the trocar site and the delivery of viable FCCs (from the tumor or malignant ascites) to the trauma site during laparoscopic surgery.

Comparison of Surgical Smoke between Two Approaches for Endoscopic Thyroidectomy and Open Thyroidectomy

“…In gasless endoscopic thyroidectomy, a suction device is connected to the suspension retractor for the suction of surgical smoke, thereby affording better air ow in the operating cavity. In the breast approach endoscopic thyroidectomy with CO 2 insu ation, the aggregated PM in surgical smoke at high concentrations is released via the trocar without ltering due to the presence of the stack effect [20], which may result in high-speed jets. Consequently, the level of emission of surgical smoke to the operating room is further increased.…”

Comparison of surgical smoke between two approaches for endoscopic thyroidectomy and open thyroidectomy

“…In gasless endoscopic thyroidectomy, a suction device is connected to the suspension retractor for the suction of surgical smoke, thereby affording better airflow in the operating cavity. In the breast approach endoscopic thyroidectomy with CO 2 insufflation, the aggregated PM in surgical smoke at high concentrations is released via the trocar without filtering due to the presence of the stack effect [20], which may result in high-speed jets. Consequently, the level of emission of surgical smoke to the operating room is further increased.…”

Laparoendoscopic Single Site Surgery for the Treatment of Huge Ovarian Cysts Using an Angiocatheter Needle

“…Another important consideration is port-site metastases during laparoscopic surgery. Ba, et al18 reported that the local microenvironment at the trocar site and specimen delivery are more important than the chimney effect. In our study, we used a laparoscopic bag to prevent port-site metastasis.…”