Total extraperitoneal access for parietal peritonectomy for peritoneal surface malignancy: The 'cocoon' technique

Area of Science:

• Surgical Oncology
• Gastrointestinal Surgery

Background:

• Complete surgical cytoreduction is the most critical prognostic factor for survival in patients with peritoneal metastases, particularly from ovarian cancer.
• Extensive procedures, including peritonectomies and multivisceral resections, are often required to achieve optimal cytoreduction.
• Cytoreductive surgery (CRS) aims to eradicate all macroscopic disease.

Purpose of the Study:

• To describe a novel surgical approach for achieving total extraperitoneal access.
• To facilitate complete parietal peritonectomy for cytoreductive surgery (CRS).

Main Methods:

• The described technique integrates established surgical approaches: anterolateral parietal peritonectomy, complete pelvic peritonectomy with sigmoid colon sleeve resection, and upper quadrant peritonectomies.
• This approach provides access to the upper abdomen, lateral abdomen, and pelvis while maintaining peritoneal integrity.

Main Results:

• The presented surgical approach enhances access to challenging anatomical sites, including the pelvis and subdiaphragmatic regions.
• It facilitates the necessary peritonectomies for complete cytoreduction in a standardized and reproducible manner.

Conclusions:

• This surgical strategy improves access for peritonectomies required for complete cytoreduction.
• The technique offers a safe, reproducible method for experienced surgical teams to manage peritoneal metastases.