Reymond M A, Hu B, Garcia A, Reck T, Köckerling F, Hess J, Morel P
Digestive Surgery, University Hospital of Geneva, Switzerland.
Surg Endosc. 2000 Jan;14(1):51-5. doi: 10.1007/s004649900010.
Multimodal therapy is used increasingly in advanced gastrointestinal tumors. Potential benefits of using an intraoperative adjuvant therapy during laparoscopy for cancer have been documented in animal studies. The aim of this study was to develop a device that could deliver such an intraoperative drug therapy.
We developed a micropump suitable for minimally invasive surgery procedures that allowed microdroplets of therapeutic substance to be distributed into the pneumoperitoneum (CO2), creating a "therapeutic pneumoperitoneum." A closed-loop control system regulates drug delivery according to the gas flow. In vitro, the micropump is able to aerosolize various aqueous and ethanol solutions, including cytostatic and bacteriostatic drugs and adhesion-modulating agents. The size of the microdroplets has been optimized to prevent visual artifacts.
The micropump was tested in an animal model (pig). The system was inserted into a 5-mm trocar. After insufflation of a 12-mm CO2 pneumoperitoneum, laparoscopic sigmoid colon resections could be performed with no special difficulties. No fog developed, and no system-related complication was observed. At autopsy, the active principle was distributed to all exposed peritoneal surfaces.
As opposed to conventional peritoneal washing, therapeutic pneumoperitoneum reaches the entire peritoneal surface, allowing an optimal drug distribution. Drug diffusion into the tissues is enhanced by the intraperitoneal pressure. Precise determination of the instantaneous and total drug quantity is possible. Therefore, this drug delivery system has several advantages over conventional irrigation. Its potential domains of application are locoregional cancer therapy, prevention of port-site recurrences, immunomodulation, analgesia, peritonitis, and prevention of postoperative adhesions.
多模式疗法在晚期胃肠道肿瘤中的应用日益广泛。动物研究已证实腹腔镜手术期间使用术中辅助疗法治疗癌症的潜在益处。本研究的目的是开发一种能够进行这种术中药物治疗的装置。
我们开发了一种适用于微创手术的微型泵，该微型泵可将治疗物质的微滴分散到气腹（二氧化碳）中，形成“治疗性气腹”。闭环控制系统根据气流调节药物输送。在体外，该微型泵能够雾化各种水溶液和乙醇溶液，包括细胞毒性和抑菌药物以及粘连调节剂。已对微滴大小进行了优化，以防止视觉假象。
该微型泵在动物模型（猪）中进行了测试。该系统被插入一个5毫米的套管针中。在充入12毫米的二氧化碳气腹后，可顺利进行腹腔镜乙状结肠切除术，未遇到特殊困难。未产生雾气，也未观察到与系统相关的并发症。尸检时，活性成分分布到所有暴露的腹膜表面。
与传统的腹膜冲洗不同，治疗性气腹可覆盖整个腹膜表面，实现最佳的药物分布。腹腔内压力可增强药物向组织内的扩散。能够精确测定瞬时和总药量。因此，这种药物输送系统比传统冲洗具有多个优势。其潜在的应用领域包括局部区域癌症治疗、预防穿刺部位复发、免疫调节、镇痛、腹膜炎以及预防术后粘连。
