The LE-HIPEC technique was invented by Dr. Marco Lotti, who developed it in 2013-2014 and published it in 2015-2016 (J Min Access Surg 2016;12:86-9), [J Laparoendosc Adv Surg Tech Part B, Videoscopy 2016;26(3)].
The LE-HIPEC technique is conceived to overcome the limits of the two major HIPEC techniques, the open abdomen technique and the closed abdomen technique, maintaining and combining their advantages.
The Hyperthermic IntraPeritoneal Chemotherapy (HIPEC) technique, which involves circulating in the abdomen a perfusion fluid containing the chemotherapeutic agents and brought to 41-42 ° C, is carried out all over the world mainly in two ways:
- Closed Abdomen Technique, in which the abdominal cavity is closed at the end of the surgical operation, leaving in the abdominal cavity some drainage tubes, through which the perfusion fluid containing the chemotherapeutic agents is circulated;
- Open Abdomen Technique (known as the Coliseum technique, with some technical variants), in which the abdomen is left open and the skin is raised to form a basin where, during perfusion, the surgeon mixes the contents of the abdomen with her/his hand.
The Closed Abdomen Technique allows better preservation of the heat of the perfusion fluid, because the closed abdomen reduces heat loss; however, several studies have shown that it is not possible to treat the abdominal cavity uniformly with this technique, because some areas of the abdominal cavity are hardly reached by the perfusion fluid. In particular, thanks to the work of Dr. Lotti, it was possible to demonstrate that the abdominal cavity is subject to the early formation of adhesions after the cytoreductive surgery, which can hinder the circulation of the perfusion fuid in the closed abdomen.
The Open Abdomen Technique (also known as the Coliseum technique, popularized by Dr. Sugarbaker), while allowing uniform circulation of the perfusion liquid, thanks to manual agitation, is burdened by intense heat dispersion: recent works show that the temperature of the perfusion fluid in the abdomen is not homogeneous with this technique and that some areas, including the superficial ones, may not reach the desired temperature or even be hypothermic. It is also not possible with this technique to treat the anterior abdominal wall adequately .
The LE-HIPEC technique involves carrying out a closed abdomen perfusion, using laparoscopy to manipulate the abdominal viscera and divide any adhesions, making it possible to circulate the chemotherapy through the whole abdominal cavity in a homogeneous and uniform way.
Dr. Lotti's critical remarks to the closed abdomen and open abdomen techniques, and the LE-HIPEC technique concept, have been presented in several publications. The technique, first published in 2015, was presented in 2016 and 2018 at the 10th and 11th Congress of the Peritoneal Surface Oncology Group International (PSOGI) in Washington, DC (USA) and Paris (France).
The LE-HIPEC technique is cited by many scientific publications, by the book "Treatment of Peritoneal Metastases, Cytoreductive Surgery, HIPEC and beyond" published by Springer, by the 2018 Guidelines "Primitive and Secondary Peritoneal Tumors" of the Italian Association of Medical Oncology (AIOM), and was taken as a model by the Odessa Polytechnic for the development of SCRUM technology applied to the control of risk and criticalities in medical projects. Thanks to the LE-HIPEC technique, the early formation of postoperative peritoneal adhesions after peritonectomy has been demonstrated for the first time in vivo, providing further support to the thesis that the traditional closed abdomen HIPEC technique is not able to treat the whole abdominal cavity effectively.
Since 2017, the article describing the LE-HIPEC technique is at the top of the “laparoscopic HIPEC” search on Google.
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