Video summary: Peritonectomy and HIPEC
March 28, 2008 § 11 Comments
This is a video I’ve made of a peritonectomy and hyperthermic intraperitoneal chemotherapy (HIPEC) for pseudomyxoma peritonei. The video is published on www.oncolex.no in Norwegian. I’ve written a short summary of the video in English.
- Preoperative MRI show:
- Tumor tissue and mucus in the abdominal cavity right up to the diaphragm.
- Tumor and mucus has pushed the small intestine to the back of the abdomen, and the colon to the anterior abdominal wall.
- Opening the abdomen reveals thick mucus in cystic cavities.
- The tumor has infiltrated the greater omentum and the transverse colon with adherences to the anterior abdominal wall.
- Dissection of the tumor/omentum along the ascending colon.
- Exposing the small intestine. Removing mucus.
- Tumor in the coecum/appendix area.
- Cutting the ileum 20 cm above the coecum with a stapler.
- Sealing and cutting the rectum with a stapler.
- Cutting adherences along the diaphragm and around the liver.
- Removing the operation specimen, consisting of the greater omentum, colon, rectum and 20 cm of the terminal ileum.
- Stripping the peritoneum from the diaphragm using electrocautery.
- Coliseum technique:
- Clamping forceps around the wound edges.
- Fixing forceps to Bookwalter’s ring using plastic strips.
- Abdominal wall forms a basin (“coliseum”).
- Placing catethers for solution flow and temperature probes in the abdomen.
- Controlling flow before covering the wound.
- The solution is circulated throughout the patient’s abdomen via a heat exchanger. It keeps the solution at 40-41 Celsius and flow at 800-1000 millilitres per minute.
- Adding chemotherapy to the solution. This is done at the start, after 30 minutes and after 60 minutes.
- Stiring the solution to spread over all surfaces.
- The chemotherapy solution is circulated with continous stiring for 90 minutes.