Cytoreduction Preparation Devices

Abstract

Cytoreduction is usually a time-consuming procedure and is associated with large areas of raw wound surfaces. In addition to the peritonectomy, often multivisceral resections may be required to achieve complete cytoreduction. The parietal peritoneum is mostly separated from the abdominal wall layers using blunt dissection. In addition to blunt dissection, a swab, scissors, or bipolar scissors can be helpful. The water jet dissector or argon beamer can likewise be useful implements to separate densely adherent peritoneum from the diaphragm or to dissect the liver capsula. Vessel-sealing instruments are particularly useful to minimize the blood loss and reduce the duration of the surgery; these instruments include bipolar scissors, Ultracision®, and LigaSure™ as well as a combination of these two methods: THUNDER BEAT®. The principles of these instruments and their preferred uses are discussed in detail.

There are no studies available in the medical literature to suggest which one is ideal for a particular operative step. The decision to use a device is usually based on its availability and the operating surgeons’ experience and comfort in using it.

Generally, there remains a risk of lateral damage to the surrounding tissues while using these electrosurgical devices during surgery. This lateral damage depends upon the duration of the exposure and the strength of the effect. The risk of lateral damage is significantly higher with monopolar current, whereas it is comparatively very low when using an electrothermal bipolar device (e.g., LigaSure) or ultrasound-based instruments (Ultracision).