• Laurent Benoit, Nicolas Cheynel, Pablo Ortega-Deballon, Giovanni Di Giacomo, Bruno Chauffert, and Patrick Rat.
• Service de Chirurgie Digestive, Thoracique et Cancérologique, CHU du Bocage, 2 Bd Mal de Lattre de Tassigny, 21079 Dijon Cedex, France.
• Ann. Surg. Oncol. 2008 Feb 1; 15 (2): 542-6.

BackgroundExposure 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.MethodsWe 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.ResultsIn 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.ConclusionThis technique allows optimal HIPEC, while limiting the potential toxic effects for the surgical, medical and paramedical teams.

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