The Clinical Challenge: What Is an \u201cInaccessible Abdomen\u201d?<\/strong><\/h2>\nPressurized Intraperitoneal Aerosol Chemotherapy (PIPAC), as well as its electrostatic evolution (ePIPAC), is administered directly into the abdominal cavity through minimally invasive laparoscopy. To perform the procedure, surgeons must insert laparoscopic instruments and insufflate gas to create a working space within the abdomen. However, approximately 4% to 5% of patients present with what is known as an \u201cinaccessible abdomen.\u201d<\/p>\n
Why does this happen? Previous abdominal surgeries often result in multiple internal adhesions\u2014dense scar tissue that causes organs to stick together. These adhesions eliminate the free space required inside the abdomen, making laparoscopic access extremely difficult and increasing the risk of injury to vital organs. Until now, patients with this condition were typically excluded from receiving PIPAC treatment altogether.<\/p>\n
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IVOQA\u2019s Innovation: Preoperative Progressive Pneumoperitoneum (PPP)<\/strong><\/h2>\nTo overcome this longstanding barrier, IVOQA adapted and refined a technique traditionally used in the management of complex hernias: Ultrasound-Guided Preoperative Progressive Pneumoperitoneum (PPP) combined with hydrodissection. Rather than forcing surgical entry, the procedure gradually prepares the abdominal cavity in the days leading up to treatment.<\/p>\n
\n- High-Precision Ultrasound Guidance: <\/strong>Using real-time ultrasound and color Doppler imaging, physicians identify the safest entry point in the abdominal wall while avoiding tumor implants and blood vessels.<\/li>\n
- Safety Through Hydrodissection: <\/strong>A fine needle is used to inject a small amount of saline solution and contrast medium, gently separating internal tissues and creating a protective artificial space of approximately 100 mL.<\/li>\n
- Gradual Pneumatic Expansion: <\/strong>A microcatheter fitted with a bacterial filter is placed to allow the controlled and intermittent insufflation of filtered air, typically between 250 and 500 mL per day, over an average period of 5.5 days. The air acts as a natural tissue expander, gradually stretching the abdominal wall and elongating adhesions in a painless and controlled manner.<\/li>\n<\/ul>\n
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Study Results: 100% Success and Outstanding Safety<\/strong><\/h2>\nThe clinical trial conducted at Viamed Santa Elena University Hospital produced remarkable results with significant implications for the medical community.<\/p>\n
\n- Complete Clinical Success (100%): <\/strong>Every patient initially classified as having an inaccessible abdomen was successfully converted into a candidate for safe laparoscopic access.<\/li>\n
- Access to Treatment Restored: <\/strong>Following PPP preparation, a total of 13 PIPAC and ePIPAC procedures were successfully administered to patients who previously had no remaining treatment options.<\/li>\n
- Excellent Safety and Tolerability: <\/strong>No patient experienced complications of any grade or adverse events related to the technique during the 30-day follow-up period, demonstrating that the procedure is highly safe and well tolerated.<\/li>\n<\/ul>\n
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Request an Expert Assessment<\/strong><\/h3>\nThe publication of this scientific milestone reinforces the commitment of Viamed Santa Elena University Hospital and IVOQA to innovation, excellence, and patient-centered care.<\/p>\n
If you or a loved one would like a second medical opinion regarding advanced treatments for peritoneal carcinomatosis, you can contact Dr. Delia Cort\u00e9s-Guiral\u2019s team at IVOQA through our standard appointment channels.<\/p>\n
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Frequently Asked Questions about the Publication<\/h2>\n\n
What Is the International Significance of This Study?<\/div>\n
This is the first report in the worldwide medical literature describing the combination of ultrasound-guided PPP with hydrodissection and PIPAC therapy. The innovation has the potential to immediately expand treatment eligibility by approximately 5% among patients with peritoneal carcinomatosis worldwide.<\/div>\n<\/div>\n
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Which Types of Cancer Were Included in the Study?<\/div>\n
The prospective study included patients with peritoneal carcinomatosis originating from colorectal adenocarcinoma, endometrioid ovarian carcinoma, and primary peritoneal mesothelioma.<\/div>\n<\/div>\n
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How Do Physicians Confirm That the Abdomen Is Safe for Surgery?<\/div>\n
On the day scheduled for aerosol chemotherapy administration, patients undergo a computed tomography (CT) scan. This imaging assessment allows physicians to evaluate air distribution and verify that the newly created intra-abdominal volume provides safe laparoscopic access.<\/div>\n<\/div>\n
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Is the Abdominal Preparation Process Painful?<\/div>\n
No. The initial placement of the microcatheter is performed under local anesthesia and propofol sedation to ensure patient comfort. Subsequently, the daily insufflation of filtered air is carefully adjusted according to each patient\u2019s tolerance. In the study, the procedure demonstrated excellent clinical acceptance throughout all treatment cycles.<\/div>\n<\/div>\n
The information in this section is for general purposes only and does not replace individual medical advice.<\/div>\n<\/div>\n