Innovative technology of total parietal peritonectomy for peritoneal carcinomatosis

BACKGROUND: Peritonectomy is an integral part of cytoreductive surgery, accompanied by a fairly high incidence of postoperative complications and mortality. In this regard, the improvement and development of easy-to-perform, low-traumatic and safe methods of peritonectomy are topical in oncology.

AIM: Based on experimental studies to develop a technology of pneumodissection of the peritoneum using carbon dioxide insufflation and evaluate its effectiveness.

MATERIALS AND METHODS: The study was conducted on 10 non-embalmed corpses of deceased people whose cause of death is not related to tumors of the abdominal cavity and pelvic organs. The Karl STORZ Thermoflator 26432020-1 Insufflator (FSZ registration certificate 2011/09444, dated 12/21/2017), carbon dioxide cylinders with a volume of 20 liters, silicone lines 1.5 meters long, 1 cm in diameter; Seldinger puncture needle 18 G; flexible polypropylene bougie 16 G were used.

RESULTS: The conducted experimental study made it possible to develop and test a method of total parietal peritonectomy based on the technology of peritoneal pneumodissection using carbon dioxide insufflation. The analysis of the obtained results made it possible to define the concept of a new technology as a method of tissue separation based on the insufflation of carbon dioxide into the connective tissue layers of the retroperitoneal space for the purpose of safe dissection of anatomical structures.

CONCLUSIONS: Peritoneal pneumodissection using gas insufflation is a new and promising technology with a number of obvious advantages. First of all, they include ease of execution, low injury, high safety and, probably, ablasticity, which can potentially create conditions for the prevention of unintentional dissemination of tumor cells in the abdominal cavity. The data obtained as a result of the experimental study allow us to conclude that pneumodissection of the peritoneum using carbon dioxide insufflation is an effective method of performing total parietal peritonectomy and can be used in performing cytoreductive surgical interventions in patients with peritoneal carcinomatosis.