Intraperitoneal hyperthermic perfusion (IPHP)

After secondary CRS, 4 Tenckhoff catheters are placed in the abdominal cavity. Two inflow catheters are placed in the right subphrenic cavity and at deep pelvic level, respectively; and two further catheters in the left subphrenic cavity and in the superficial pelvic site.

Schema of Intra Peritoneal Hyperthermic Perfusion

The device The IPHP requires the employment of lung-heart machine, comprised by a roller pump, a thermostat, a heat exchanger and an extra corporeal circuit. The perfusate flow is controlled as well as the heat exchanger adjusts the temperature of perfusate, by circulating water at a desired temperature in the arterial phase of circuit. The extra corporeal circuit consists of interconnected tubes which has: a) an input section (inflow); b) an output section (outflow); c) an axis of rapid filling up; d) a central body connected with a filter; e) a deflow section; f) a series of multiperforated catheters in their extremities. The device should be approved by C.E accreditation. Several centers are using the Performer LRT®, RAND, Medolla (MO), Italy.

The perfusate

The perfusate, defined as the liquid filling the circuit could be of various type: a) peritoneal dialysis solution, physiologic solution or a composition of Normosol solution R pH 7.4 associated with Haemagel (in the proportion 2:1). The priming volume ought to be abundant enough to achieve homogeneity and constancy of heating, but not excessive, in order to avoid abdominal distension and bodily thermo-dilution. For an optimal working of circuit 2l/m2 of perfusate for opened technique and 6 l for closed technique is usually sufficient.

The drugs schedule

In the closed technique the skin of abdominal wall is temporary closed with a running suture and the Tenckhoff catheters connected to the circuit, in order to initiate the IPHP. In the open modality, also known as Coliseum technique, the abdomen is covered with a plastic sheet and drug vapor is evacuated to protect the operating room personnel.
The catheters are connected to the extra-corporeal circuit and the preheated polysaline perfusate containing Cisplatin and Adriamycin is instilled in the peritoneal cavity using the heart-lung pump at a mean flow of 600 - 1000 ml/min for 90 minutes. In order to achieve intrabdominal temperature of 42.5C, we will maintain the inflow temperature of approximately 44C. Throughout the perfusion, if the opened technique is adopted; the surgeon will continuously manipulate the viscera to distribute both heat and chemotherapy. Following perfusion, the perfusate is quickly drained and the abdomen closed after careful intraperitoneal inspection.