Zentralbl Chir 2011; 136 - P_28
DOI: 10.1055/s-0031-1289059

Description of a novel approach for intraperitoneal drug delivery and the related device

W Solass 1, A Hetzel 2, G Nadiradze 3, E Sagynaliev 3, MA Reymond 3
  • 1Otto-von-Guericke Universität Magdeburg, Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Magdeburg, Germany
  • 2Reger Medizintechnik, Rottweil, Germany
  • 3Evangelisches Krankenhaus Bielefeld, Klinik für Allgemein- und Viszeralchirurgie, Bielefeld, Germany

Aims: Two significant limitations of intraperitoneal drug therapy are (1) limited drug distribution and (2) poor penetration into peritoneal nodules. A possible solution is the application of the so-called ‘therapeutic pneumoperitoneum’, taking advantage of the gaseous nature and of the pressure of capnoperitoneum during laparoscopy. Objective was to develop a device able to apply such therapeutic pneumoperitoneum.

Methods: 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 5 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 minutes (4 test animals w/therapeutic pneumoperitoneum (12mmHg CO2) and 1 control animal w/conventional lavage (2 liters intraabdominal volume with extracorporeal circulation). At the end of the procedure, all animals were autopsied and the peritoneum 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).

Results: Stained peritoneal surface was larger after aerosol application, as compared to 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.

Conclusions: 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.