Description of a novel approach for intraperitoneal drug delivery and the related device
- 12 May 2012
- journal article
- Published by Springer Science and Business Media LLC in Surgical Endoscopy
- Vol. 26 (7), 1849-1855
- https://doi.org/10.1007/s00464-012-2148-0
Abstract
Two significant limitations of intraperitoneal drug therapy are limited drug distribution and poor penetration into peritoneal nodules. A possible solution is the application of the so-called “therapeutic pneumoperitoneum,” taking advantage of the gaseous nature and the pressure of capnoperitoneum during laparoscopy. Our objective was to develop a device able to apply such therapeutic pneumoperitoneum. The technology presented here is a spraying device and can be introduced through a trocar. It is driven by mechanical pressure and consists of an injector, a line, and a nozzle. An in vivo experimental study was performed in five pigs. A transvaginal cholecystectomy was performed. At the end of the procedure, a standard dose of methylene blue was sprayed/infused into the abdominal cavity for 30 min (4 test animals w/therapeutic pneumoperitoneum (12 mmHg CO2) and 1 control animal w/conventional lavage (2 l intra-abdominal volume with extracorporeal circulation)). At the end of the procedure, all animals were autopsied and the peritoneum was analyzed. Outcome criteria were: (1) drug distribution (as assessed by the stained peritoneal surface at autopsy), and (2) diffusion into the peritoneum (presence or not of macroscopic staining of the outer aspect of the peritoneum immediately after surgery). Stained peritoneal surface was larger after aerosol application compared with peritoneal lavage, and staining more intense. Hidden peritoneal surfaces and the anterior abdominal wall were stained only in the aerosol group. In contrast to peritoneal lavage, the outer aspect of peritoneal membrane was immediately stained after pressurized spraying. This device and the related approach significantly improve both distribution and penetration of a test substance into the peritoneal cavity in a large animal model. This might be a significant progress in treating intraperitoneal disease, in particular peritoneal carcinomatosis.Keywords
This publication has 20 references indexed in Scilit:
- The Pharmacokinetics of Ropivacaine After Intraperitoneal AdministrationAnesthesia & Analgesia, 2010
- Curative treatment of colorectal peritoneal carcinomatosis: Current status and future trendsEuropean Journal of Surgical Oncology, 2010
- Complete Cytoreductive Surgery Plus Intraperitoneal Chemohyperthermia With Oxaliplatin for Peritoneal Carcinomatosis of Colorectal OriginJournal of Clinical Oncology, 2009
- An Evaluation of Gas Humidifying Devices as a Means of Intraperitoneal Local Anesthetic Administration for Laparoscopic SurgeryAnesthesia & Analgesia, 2008
- The effect of continuous intraabdominal nebulization of lidocaine during gynecological laparoscopic procedures- a pilot studyGynecological Surgery, 2008
- Respectons le Péritoine ! C’est notre première ligne de défense contre la carcinoseJournal de Chirurgie, 2007
- Laparoscopic spray application of fibrin sealant effects on hemodynamics and spray efficiency at various application pressures and distancesSurgical Endoscopy, 2007
- Intraperitoneal Cisplatin plus Intravenous Cyclophosphamide versus Intravenous Cisplatin plus Intravenous Cyclophosphamide for Stage III Ovarian CancerThe New England Journal of Medicine, 1996
- Peritonectomy ProceduresAnnals of Surgery, 1995
- Intracavitary chemotherapyCritical Reviews in Oncology/Hematology, 1985