Surgical education video: Laparoscopic Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Ovarian Cancer

The purpose of this video is to illustrate the operative steps and perioperative considerations of minimally-invasive HIPEC.

This procedure was performed at a tertiary academic medical center, within the Division of Gynecologic Oncology.

Case presentation: A 32-year-old woman presented with a complex pelvic mass. She underwent primary cytoreductive surgery, including exploratory laparotomy, total abdominal hysterectomy, bilateral salpingo-ophorectomy, pelvic peritoneal stripping and omentectomy, with no gross residual disease. Final pathology revealed FIGO stage IIIA2 small cell ovarian carcinoma, hypercalcemic type (SCCOHT) with somatic SMARCA4 mutation. The patient completed four cycles of adjuvant vinblastine, cisplatin, cyclophosphamide, bleomycin, doxorubicin and etoposide (VPBCAE), followed by second-look laparoscopy and HIPEC with 130 mg of cisplatin. The patient's treatment plan followed the Cincinnati protocol with surgical cytoreduction, VPBCAE, second-look HIPEC and bone marrow transplant.

The procedure began with diagnostic laparoscopy and placement of bilateral lower quadrant 10 mm ports. The patient's body temperature was lowered to 34°C. Inflow tubing was placed through a lower quadrant port site. Perforations were made in the outflow tubing using a 3 mm punch biopsy, which was placed along the surface of the liver. The abdomen was rinsed with saline until outflow reached 40°C. The abdomen was instilled with cisplatin and agitated for 90 min. The patient's body temperature remained at 36-38°C throughout the procedure. The abdomen was rinsed with 2 L saline. Diagnostic laparoscopy was again performed prior to closure.

HIPEC has emerged as a promising adjunct to cytoreductive surgery. Understanding its technical considerations and clinical application is essential.