Fluorescence guided total robotic parietal peritonectomy, cytoreductive surgery and closed HIPEC

Abstract

Introduction and Objectives

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is increasingly used for peritoneal surface malignancies, shifting from open to minimally invasive approaches for lower Peritoneal Carcinomatosis Index(PCI) cases. Robotic surgery's benefits include enhanced visualization, ergonomics, and reduced complications, supporting its adoption in oncologic procedures. We'll outline a step-by-step technique for Fluorescence-Guided Total Robotic Parietal Peritonectomy, Cytoreductive Surgery, and closed HIPEC in advanced peritoneal carcinomatosis.

Patient and Surgical Procedure

In this demonstration, we outline the procedure for performing a robotic total parietal peritonectomy with cytoreductive surgery and HIPEC in a 45-year-old patient diagnosed with stage IIIC ovarian cancer and peritoneal carcinomatosis, following three cycles of neoadjuvant chemotherapy (NACT). We highlight the utilization of Indocyanine Green-Near Infrared (ICG-NIR) guided real-time imaging to assess peritoneal deposits post-chemotherapy and guide lymph node dissection.

Results

In this case, with a PCI of 15, complete cytoreduction (CC0) was achieved using a minimally invasive robotic approach with HIPEC. The procedure had a short docking time of 22 min and a total console time of 300 min. HIPEC lasted 90 min, and the total operative time, including surgery and HIPEC, was 410 min with minimal blood loss. The patient was discharged on Post operative day 3, showcasing the benefits of this approach in achieving rapid recovery and short hospital stays for peritoneal surface malignancies.

Conclusion

Robotic technology like ICG-NIR imaging and advanced tools has boosted the speed and safety of CRS and HIPEC. Success hinges on careful patient selection. The future promises even less invasiveness and better outcomes for peritoneal surface malignancies with minimally invasive and multimodal approaches.