Intraperitoneal Catheter Placement Research Articles

Laparoscopic-assisted intraperitoneal placement of lumboperitoneal shunt in patients with idiopathic intracranial hypertension

BackgroundLumboperitoneal (LP) shunting is an effective treatment option aiming at cerebrospinal fluid diversion in cases of idiopathic intracranial hypertension. Confirming the distal end position, on the other hand, could be technically difficult, especially in obese people. With minimal invasive procedures, laparoscopic-assisted placement of the peritoneal side of the LP shunt became a valid treatment option. In this study, we aim to evaluate the operation duration, possible complications, and patient outcomes after the placement of a peritoneal catheter using the laparoscopically assisted technique.MethodsA retrospective analysis of clinical, preoperative, and postoperative data for 18 patients diagnosed with idiopathic intracranial hypertension and undergoing LP shunt surgery using the laparoscopic-assisted technique for intraperitoneal catheter placement between 2019 and 2021 was performed.ResultsThe average operating time was 93.89 min, and the average hospital stay was 2.3 days. There was no mortality among cases treated with the described technique, and no intraoperative complication occurred. Seven patients (38.9%) had LP shunt failure, with a median duration to failure of 212 days; three cases for slippage, two cases had over drainage, one case had peritoneal adhesions around the shunt tip, and one case had Arnold Chiari malformation.ConclusionsThe laparoscopic assisted technique is safe and feasible. It allowed a direct vision of the shunt tip position within the peritoneal cavity which helped in confirming position and assessing function, resulting in a superior option over classic surgical options. Short hospital stay, minimal postoperative pain, and low failure rates are the main advantages of described technique.

Intraperitoneal Catheter Placement: The “Hammock” Technique

BackgroundOvarian cancer is the leading cause of death from gynecologic malignancies in the United States. The NCI released a clinical announcement supporting the use of intraperitoneal chemotherapy in addition to intravenous chemotherapy. However, multiple trials have shown that IP administration is severely limited by catheter complications. PurposeWe present a new technique for inserting and securing IP catheters in order to prevent the previously reported complications, in particular obstruction of the catheter, bowel and vaginal cuff perforation. MethodsFrom March 2006 through February 2010, 38 patients with stage III or IV ovarian cancer underwent optimal cytoreductive surgery and had an IP catheter placed via the “Hammock” technique. Results14 patients underwent modified posterior exenteration (37%); 6 underwent splenectomy (16%); thirteen small bowel resections (34%). All 38 patients underwent pelvic and aortic lymphadenectomy. Two patients had reservoir complications; one “flipped over”, and the other had an infection at the port site. Both patient’s elected to discontinue the IP portion of the chemotherapy regimen. 219 cycles of chemotherapy were completed (96%) out of a possible 228 cycles. The only complications were related to the reservoir. There were no catheter-related complications. ConclusionAs an increasing number of IP catheters are placed at the time of cytoreductive surgery, we will continue to have catheter complications and IP chemotherapy administration difficulties. In using the “Hammock” Technique, we had no catheter complications, and a 96% chemotherapy completion rate. We recommend using the “Hammock” Technique for inserting and securing IP catheters at the time of cytoreductive surgery. .

Early Postoperative Intraperitoneal Chemotherapy Following Cytoreductive Surgery for Appendiceal Mucinous Neoplasms With Isolated Peritoneal Metastasis

Although cytoreductive surgery and intraperitoneal chemotherapy have been advocated as standard treatment for appendiceal neoplasms with isolated peritoneal metastasis, the optimal method of chemotherapy administration has not been established. At our institution, patients undergoing complete cytoreduction in this setting typically receive multiple cycles of early postoperative intraperitoneal chemotherapy. The aim of this study was to describe patients with appendiceal neoplasms and peritoneal dissemination treated with complete cytoreductive surgery and early postoperative intraperitoneal chemotherapy and to document associated time to progression and morbidity. This is a retrospective study at a single specialty institution. Hospital and departmental databases were searched for patients presenting with primary appendiceal neoplasms undergoing cytoreductive surgery, placement of intraperitoneal port, and subsequent intraperitoneal chemotherapy from June 1995 to September 2009. This study was conducted at Memorial Sloan-Kettering Cancer Center. We identified 50 patients (30 female), median age 48 (range, 26-66) who met the criteria. Cytoreductive surgery, placement intraperitoneal port, and intraperitoneal chemotherapy were performed. All patients underwent intraperitoneal catheter placement after complete cytoreductive surgery, followed by a median of 4 cycles (range, 1-9) intraperitoneal 5-fluoro-2'-deoxyuridine (1000 mg/m daily for 3 days) plus leucovorin (240 mg/m). The median hospital length of stay was 9 days (maximum, 29). Thirty-four percent of the patients experienced complications; 12% experienced major complications (3 abdominal abscesses, 1 deep vein thrombosis, 1 abdominal hemorrhage, and 1 intraperitoneal port malfunction). There were no 30-day mortalities. Five-year recurrence-free interval was observed in 43%. Among 23 patients with recurrence, 18 had a recurrence only within the peritoneum. The median overall survival was 9.8 years. This is a retrospective study. Many patients had surgery first at other institutions; therefore, pathologic examination of resected material was not possible in every case. Other factors possibly impacting time to recurrence (ie, preoperative chemotherapy, duration between onset of disease and presentation to our institution) varied among patients and were not controlled for. In the absence of a control arm undergoing complete cytoreduction without early postoperative intraperitoneal chemotherapy, we did not ascertain whether intraperitoneal chemotherapy confers additional benefit. Cytoreductive surgery plus multiple cycles of early postoperative intraperitoneal chemotherapy is safe, achieving survival results similar to published outcomes of other protocols (including hyperthermic intraperitoneal chemotherapy). Prospective trials are warranted to compare various methods of intraperitoneal chemotherapy in this setting.

Effect of increased intra-abdominal pressure on urinary system development in fetal rabbits

AimTo investigate the effect of increased intra-abdominal pressure (IAP) on the fetal urinary system. Materials and methodsPregnant rabbits (15-day gestation) were used. Control (n = 5) and experimental (EG, n = 4) groups underwent intraperitoneal catheter placement. The IAP was increased by intraperitoneal air insufflations during the third trimester in the EG. At term, organ weight and organ weight/body weight (BW) ratios were noted, histological examination of the urinary system organs was performed, and the apoptotic indexes were calculated. ResultsBW and total renal weight were significantly increased in the EG (38.65 ± 8.34 g vs 49.36 ± 8.81 g, p = 0.008; and 0.406 ± 0.132 g vs 0.531 ± 0.129 g, p = 0.02). Total renal weight/BW ratio did not differ between groups (0.0103 ± 0.001 vs 0.0107 ± 0.001; p = 0.33). Bladder weight and bladder weight/BW ratio was also significantly increased in the EG (0.067 ± 0.014 g vs 0.114 ± 0.026 g, p = 0.00; and 0.00175 ± 0.00026 vs 0.00229 ± 0.00036, p = 0.001). Immature glomeruli and collecting tubules, and a thin and underdeveloped muscular layer in the ureter and bladder were encountered in the EG, and the apoptotic cell index was significantly increased (p < 0.05). ConclusionIncreased IAP has an adverse effect on fetal urinary system development, and may play a role in the pathogenesis of various congenital abnormalities of the urinary system.

It's not just for laparoscopy anymore: Use of insufflation under ultrasound and fluoroscopic guidance by Interventional Radiologists for percutaneous placement of intraperitoneal chemotherapy catheters

ObjectivesWhile intraperitoneal (IP) chemotherapy has shown significant survival benefits, the ability to successfully deliver IP chemotherapy has been limited. In GOG 172, surgically-placed IP catheters had a reported complication rate of 34%. In addition, IP catheters have to be placed surgically. We have developed a novel percutaneous placement technique for IP catheters in patients without ascites. MethodsThis study was a retrospective analysis of all patients receiving percutaneously-placed IP catheters from 12/2008 to present. Catheters were placed using a two-step technique under conscious sedation. IP access was gained using ultrasound-guided peritoneal puncture over the right lobe of the liver. A 5 Fr catheter was placed into the peritoneal cavity and the abdomen insufflated with carbon dioxide (CO2). Access was gained in the RLQ once distention separated the bowel from the abdominal wall. A 14.5 Fr multi-side hole catheter was coiled in the pelvis, and a reservoir tunneled onto the lower anterior chest wall. For this analysis, abstracted data included patient demographics, indication for catheter placement, complications (procedural and with chemotherapy delivery), fluoroscopy time, and timing/indication of catheter removal. ResultsEleven patients received IP catheters. The mean age was 58years, mean body mass index was 27.1, and mean number of days from surgical debulking was 38. There were two stage 2, and eight stage 3 patients. Two patients had fallopian tube, and nine patients had ovarian cancer. All patients had an optimal debulking procedure. Seven of 11 patients also obtained central intravenous access when the IP port was placed. Follow-up data were as follows: Average fluoroscopy time was 9min. One patient (9%) had an intra-procedural complication but the catheter was successfully placed. Zero patients had catheter-related complications in the course of receiving chemotherapy. Five of the 11 patients (45%) completed the planned IP chemotherapy treatments, with three additional patients (27%) currently receiving therapy. The remaining three patients (27%) discontinued chemotherapy for reasons unrelated to IP catheter function: two due to chemotherapy side effects, and one with sepsis from a perforated diverticulum. ConclusionsThus far, our experience with percutaneous placement of IP catheters is associated with a low risk of catheter-related complications and high technical success rates. CO2 insufflation may make peritoneal puncture easier and potentially safer. This procedure offers an alternative to surgical placement, even in patients without clinically significant ascites.

Peritoneal Catheter Site Metastasis in a Patient With Advanced Ovarian Cancer

Refractory ascites can significantly reduce quality of life in patients with advanced stage ovarian cancer. Paracentesis is a commonly used procedure for the management of refractory ascites. However, there are potential risks associated with paracentesis such as pain, infection, and injury to intra-abdominal organs. In an effort to decrease the number of serial paracentesis, placement of intraperitoneal catheters has been described for the management of intractable ascites. Here we describe a case of metastasis involving a palliative peritoneal catheter in a patient with recurrent ovarian cancer.

Intraperitoneal catheter placement for pharmacological imaging studies in conscious mice

Imaging studies that use rodents sometimes involve intraperitoneal administration of pharmacological compounds. To facilitate such studies, the authors developed a simple and easily mastered technique for placing an intraperitoneal catheter in a conscious mouse. This technique eliminates the need to remove the animal from the scanner to administer a drug through the intraperitoneal route.

Increased maternal intraabdominal pressure alters the contractile properties of fetal rabbit bladder

Background/Purpose Increased intraabdominal pressure (IAP) causes impairment of urine flow by compressing the urine-transporting structures and leads to development of various types of anatomical and functional abnormalities in the urinary system. An intrauterine experiment was conducted to determine the relationship between IAP and intraamniotic pressure (IAMNP) and the effects of increased IAMNP on the contractile properties of fetal bladder in the rabbit model. Materials and Methods Fourteen time-mated pregnant rabbits were used. A preliminary study (n = 5, 20-day gestation) was performed to determine the relation between IAP and IAMNP. Intraabdominal pressure and IAMNP were recorded through an intraperitoneal catheter and 2 intraamniotic transducers, respectively. Basal IAP and IAMNP were recorded. Then, IAP was increased for 4 cm H 2O in each subsequent 30-minute period until reaching 20 cm H 2O. Control (n = 5) and experiment (n = 4) group animals underwent intraperitoneal catheter placement in the 15th day of gestation. Intraabdominal pressure was increased by intraperitoneal air insufflations from 20th day to term in the experiment group. At term, the fetal bladders were excised and the contractile activity was then recorded isometrically. Electrical field stimulation was applied, and contractile responses to carbachol and high potassium (20 mmol/L KCl) were also evaluated. Results A strong relationship was found between IAMNP and IAP and defined as IAMNP = IAP × 0.8 + 2.0 ( R 2 = 0.816, P = .000). Increased IAP did not change basal rhythmic activity but resulted in frequency-related electrical field stimulation responses being higher contractility responses for frequencies below 10 Hz ( P < .05) and similar responses at and above 10 Hz. Bladders imposed to elevated IAP displayed greater sensitivity to carbachol with a shift to the left in the concentration-response curve. High potassium–induced contractions had a shorter rise time ( P < .05) but similar contraction amplitudes and half decay times in bladders imposed to increased IAP. Conclusion Intraamniotic pressure is affected by IAP in pregnant rabbits in accordance with an equation (IAMNP = IAP × 0.8 + 2.0). Increased IAMNP changes contractile properties of the fetal rabbit bladder without affecting spontaneous activity and shortens the rise time of high potassium–induced contractions. Increased IAMNP also results in cholinergic hypersensitivity in fetal bladders. These results may explain the mechanism of dysfunctional voiding and abnormal bladder function observed in conditions in which IAP and/or IAMNP are elevated.

Intraperitoneal Chemotherapy for Ovarian Cancer: Overview and Perspective

Intraperitoneal (IP) chemotherapy has theoretical, pharmacologic, and clinical advantages over intravenous (IV) chemotherapy in women with optimally debulked epithelial ovarian cancer confined to the abdominal cavity. Consistent, statistically significant improvements in both progression-free and overall survival have been demonstrated in three large phase III trials conducted in the United States during the past 10 years. Nevertheless, concerns over IP drug distribution and systemic absorption, technical challenges of IP catheter placement and the incidence of IP catheter-related complications, and the clinical relevance of these studies have limited the adoption of IP therapy in ovarian cancer. Current interest in the evaluation of molecularly targeted therapies should build on the progress that has been made through the use of IP chemotherapy in women with optimally debulked ovarian cancer.

Maximizing the Delivery of Intraperitoneal Therapy While Minimizing Drug Toxicity and Maintaining Quality of Life

This decade has witnessed three large randomized trials (SWOG 8501/GOG 104, GOG 114, and GOG 172) clearly showing the advantages of intraperitoneal (IP) chemotherapy over systemic/intravenous therapy in treating selected patients with advanced stage ovarian cancer. Despite showing an impressive increase in median progression-free survival and median overall survival, complications in IP chemotherapy delivery and drug-related toxicities reported in these studies have hindered widespread acceptance and implementation of first-line IP therapy. Some of these complications and drug-related toxicities are treatment-limiting and need special attention. Success of IP therapy as a first-line choice of treatment is dependent upon ideal patient selection, effective delivery of appropriate doses of chemotherapy agents to the tumor site, and efficient management of complications. With proper orientation and instruction in IP catheter placement and patient management, these obstacles can be overcome, allowing for successful administration of IP therapies. This review article discusses clinical approaches to maximize the delivery of IP therapy while minimizing catheter complications. Mitigating drug toxicities with the use of cytoprotectants such as amifostine and preventing infection with the use of agents, such as amifostine and pegfilgrastim, are discussed in detail.

Phase I/pharmacology study of intraperitoneal (IP) 3–5 day topotecan alone and with cisplatin:on day 1: potential for consolidation in ovarian cancer

5045 Background: Consolidation following 1st-line treatment is a strategy being explored to improve results in advanced ovarian cancer. Topotecan has schedule dependent toxicity alone and combination with cisplatin. We sought to evaluate repetitive doses of IP topotecan alone and in combination with cisplatin. in patients with stage III ovarian cancers undergoing reassessment. Methods: Reasessed patients underwent placement of IP catheters and enrolled in a dose-escalation design to the following levels: topotecan 1.5 mg D1–5 (level 0) alone and with cisplatin 50mg/m2 D1 and topotecan 1.5mg D1–3 (level I). Dose-limiting toxicity (DLT) led to de-escalation to topotecan 1.25mg D1–3 (level II), and topotecan 1.25 mg/m2 D1–5 (level III). Plasma and lactone topotecan was measured d1, d2 on cycles 1 and 2 with IP fluid total measured d2 on both cycles(a minimum of 4 cycles were planned). Results: 15 with epithelial ovarian or tubal cancer and 1 with gastric cancer were entered (number) at levels 0 (3), I (4), II (4), and III (5). Ovarian cancer patients had minimal (6) or no residuum (3) after platinum-based induction, 4 were entered for documented peritoneal recurrences, and 2 for cytologic recurrence after IP cisplatin/FUDR DLT (neutropenia) was noted in 7 patients at dose levels 1 and 3; grade 3 thrombocytopenia occurred in 2 at level 3. Other toxicities: grade 1hives (2) and creatinine elevations (2), S epidermidis and chemical peritonitis (1 each) after cycle 2. Patients treated at first reassessment had a recurrencence free survival not reached with > 42 w (62–148w) for all patients. Pharmacology demonstrates 20–100x pharmacologic advantage AUC IP/AUC plasma for topotecan. Conclusion: Topotecan has excellent local tolerance and myelosuppression is dose-limiting. IP consolidation with topotecan alone or with cisplatin at dose level II should be tested in Phase III trials. No significant financial relationships to disclose.

Atlas of Procedures in Gynecologic Oncology

Levine DA, Barakat RR, Hoskins WJ. Atlas of Procedures in Gynecologic Oncology. 279 pages. New York and London: Martin Dunitz, Taylor & Francis Group plc, 2003. ISBN1-84184-196-X. Hardback price: GBP 135.00. According to the preface, the purpose of this atlas is to provide a detailed overview of the major procedures performed by gynecologic oncologists, using full-color photographs. The more than 800 images presented are of high quality on glossy paper, and the overall size is appropriate. The authors are experienced authorities in gynecologic oncology working at the Memorial Sloan-Kettering Cancer Center, New York, and at the Curtis and Elisabeth Anderson Cancer Institute, Savannah, Georgia. Dr Hoskins also serves as associate editor of the journal Gynecologic Oncology. Besides the authors there are 26 contributors, two of them from outside America. For European readers the atlas would have been even more relevant if more contributions had come from, for example, France and Germany. Standard procedures including surgical cytoreduction, radical abdominal hysterectomy, pelvic exenteration and various laparoscopic procedures are demonstrated with very good photos. Vaginal trachelectomy for fertility conservation in patients with early cervical cancer is also shown. Vulvectomy and the use of the sentinel node mapping is nicely presented. I would, however, have expected some pictures on methods for reconstructive surgery of the vulva. There are also some repetitions: three different chapters show laparoscopic pelvic lymph node dissection. Various smaller procedures commonly used in oncology are also shown. It seems, however, a little exaggerated to present 15 photos illustrating paracentesis, and 17 photos on the placement of a central venous catheter, a procedure that is commonly performed by the anesthesiologist. Appendectomy is covered by 18 photos, which is far too many. Although important in gynecologic oncology, brachytherapy seems a little misplaced among all the surgical procedures. The authors stress that they have made great efforts to preclude the use of sketches. In some cases, however, it might have been more informative and easier to understand if drawings of deeply located structures had accompanied the photos and if caudal–cephal and medial–lateral directions had been indicated. The book is accompanied by a valuable DVD that covers four chapters on laparoscopic surgery, namely, laparoscopic procedures of surgical staging, radical hysterectomy, extraperitoneal lymph node dissection, and second-look laparoscopy with intraperitoneal catheter placement. The indications, instruments and main surgical steps are outlined with comments on anatomical landmarks and precautions. In summary, this atlas is well done, although it could have been more strictly edited. For residents in training it can serve as a good introduction to various surgical procedures. Experienced gynecologic oncologists will also benefit from the presentations of new technologies.

Fluoroscopically Guided Peritoneal Catheter Placement for Intraperitoneal Chemotherapy

Surgical placement of intraperitoneal catheters for intraperitoneal chemotherapy is associated with bowel perforation, peritonitis, and catheter occlusion. The authors evaluated the safety and efficacy of fluoroscopically guided placement of temporary intraperitoneal catheters for chemotherapy. Two hundred one intraperitoneal catheter placements were attempted in 88 patients with peritoneal carcinomatosis or sarcomatosis. The peritoneum was punctured with 22-gauge needles and exchange was made with use of Seldinger technique and liberal injections of contrast material at each step for 8.3- or 8.5-F multiple-side-hole catheters. Placement sites included all four quadrants and the midline. Computed tomographic (CT) peritoneography was performed prior to chemotherapy. One hundred ninety (94.5%) of 201 attempted catheter insertions were technically successful. Results of CT peritoneography were available in 175 cases and showed free distribution of peritoneal contrast material in 39% (n = 69), partial loculation in 38% (n = 67), and extensive loculation in 22% (n = 39). Catheters remained in place for a median of 5 days (range, 2-6 days). Significant complications occurred in 11 procedures (5.5%). There were seven unintended bowel intubations; all were treated conservatively except one that required surgical repair. One other patient developed necrotizing fasciitis requiring surgical débridement. Three other patients (1.5%) developed mild peritonitis responsive to antibiotics. Technical success, complications, and peritoneal distribution of contrast material did not correlate with the site of catheter placement. Percutaneous catheter placement with use of small-gauge needles for initial puncture is safe and efficacious in patients requiring short-term peritoneal access for chemotherapy.

Intraperitoneal femoral venous catheter insertion with free blood return in presence of tense hemoperitoneum

The authors report a case of intraperitoneal insertion of a femoral venous catheter, with blood return, in a patient with hemoperitoneum. In such patients, skin puncture at or below the inguinal ligament is important. Aspiration of unusually dark blood and medial catheter location should raise the possibility of intraperitoneal catheter placement.

A method for continuous flow, single-pass peritoneal dialysis: Preliminary communication

A technique for single-pass, continuous flow peritoneal dialysis is described. Urea clearances vary in proportion to the dialysate flow rate, to a maximum of 52 ml/min at 210 ml/min flow. These clearances are somewhat greater than those previously reported for this method but are lower than the rates reported for the chronic dialysis coils. Present costs are approximately $13 per dialysis and can probably be further reduced. In this limited experience, bacterial infection has not been a problem if meticulous technique is observed. Protein loss is variable. The risks and hazards relate primarily to those associated with intraperitoneal catheter placement.