title: Closed hyperthermic intraperitoneal chemotherapy with open abdomen: a novel technique to reduce exposure of the surgical team to chemotherapy drugs.
abstract: BACKGROUND
  Exposure of the surgical team to toxic drugs during hyperthermic intraperitoneal chemotherapy (HIPEC) remains a matter of great concern. During closed-abdomen HIPEC, operating room staff are not exposed to drugs, but the distribution of the heated liquid within the abdomen is not optimal. With open-abdomen HIPEC, the opposite is true. Although the open-abdomen method is potentially more effective, it has not become a standard procedure because of the risk of exposure of members of the team to drugs.
  
  
  METHODS
  We present a new technique (closed HIPEC with open abdomen) which ensures protection against potentially contaminating exposure to liquids, vapours and aerosols, and allows permanent access to the whole abdominal cavity. Its principle is to extend the abdominal surgical wound upwards with a sort of "glove-box". The cutaneous edges of the laparotomy are stapled to a latex "wall expander". The expander is draped over a special L-section metal frame placed above the abdomen. A transparent cover containing a "hand-access" port, like those used in laparoscopic surgery, is fixed inside the frame.
  
  
  RESULTS
  In 10 patients, this device proved to be hermetic for both liquids and vapours. Intra-abdominal temperature was maintained between 42 and 43 degrees C during most of the procedure. The whole abdominal cavity was accessible to the surgeon, allowing optimal exposure of all peritoneal surfaces.
  
  
  CONCLUSIONS
  This technique allows optimal HIPEC, while limiting the potential toxic effects for the surgical, medical and paramedical teams.
authors.affiliation: Service de Chirurgie Digestive, Thoracique et Cancérologique, CHU du Bocage, 2 Bd Mal de Lattre de Tassigny, 21079 Dijon Cedex, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Benoit
authors.forename: Nicolas
authors.initials: N
authors.lastname: Cheynel
authors.forename: Pablo
authors.initials: P
authors.lastname: Ortega-Deballon
authors.forename: Giovanni Di
authors.initials: GD
authors.lastname: Giacomo
authors.forename: Bruno
authors.initials: B
authors.lastname: Chauffert
authors.forename: Patrick
authors.initials: P
authors.lastname: Rat
mesh_terms: D034841:Abdominal Cavity; D001831:Body Temperature; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000295:instrumentation / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology; D003131:Combined Modality Therapy; D013505:Digestive System Surgical Procedures; D006801:Humans; D006979:Hyperthermia, Induced; D010535:Laparoscopy; D009784:Occupational Diseases / Q000517:prevention & control*; D009873:Operating Rooms; D010348:Patient Care Team; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery*; D011553:Pseudomyxoma Peritonei / Q000601:surgery