# How is the procedure carried out?

The Intra-abdominal surfaces are "lavaged", i.e. cleansed, through placement of four drains. These four "drains" are connected to an external circuit that acts as a pump. Two of them are used as drug administration routes. The others are placed at the center of the abdominal area and on the surface of the pelvis respectively and are used for the lavage return. The circulating solution of the chemotherapeutic agent is at a temperature of approximately 42° - 43° C due to the special system that keeps it at this temperature.

There are two ways to carry out this procedure, the open one (figure 1) and the closed one (figure 2).

In hyperthermic intraperitoneal chemotherapy, chemotherapeutic agents may be administered in very high concentrations.

The chemotherapeutic agent solution remains in the peritoneal circulation for a period of approximately one and a half hour achieving a flow of more than half a liter per minute. This way, the abdominal cavity is fully cleansed using the pharmaceutical solution and even free cancer cells can be reached. As soon as the treatment is concluded, the chemotherapeutic fluid used is fully suctioned outside of the abdominal cavity. Before we open the abdominal wall anew, we perform another abdominal lavage lasting about 5 minutes. Afterwards, we open the abdominal wall and perform another lavage of the abdominal cavity using lukewarm saline whereby we try to remove any remaining pieces of issue (from the condition) or clots using our hands.