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Ray et al. J Cancer Metastasis Treat 2020;6:9 I http://dx.doi.org/10.20517/2394-4722.2020.16 Page 5 of 9

Figure 4. Demonstrating the creation of coliseum for performing hyperthermic intraperitoneal chemotherapy

Figure 5. Showing the coliseum (semi-open technique) and hyperthermic intraperitoneal chemotherapy tubes with adhesive sheet

HITAC: technical aspects
HIPEC was performed using the open Coliseum technique [Figure 4] as described by Sugarbaker . We
[3]
used the Omni-Tract surgical retractor for exposing the abdominal cavity. Skin edges were suspended
using interrupted polyester sutures fixed to the horizontal arms of the retractor to create an open space in
the abdominal cavity, as depicted in Figure 4. An avascular plane of about 2-3 cm was routinely created
between the anterior rectus sheath and subcutaneous tissue so that the rectus sheath and muscle would be
immersed in the HIPEC perfusate.

An adhesive plastic sheet was incorporated to prevent spillage of the chemotherapy solution and heat loss
[Figure 5]. A slit was made in the plastic cover to allow manual access to the abdomen and pelvis during
HITAC. This helped in cases of blocked tubings during HIPEC and was also used to ensure uniform
distribution of the perfusate and heat by constant, intermittent manipulation of the perfusate. A specially
designed wooden spatula was used for stirring the heated chemotherapy solution to ensure uniform
distribution as well as heat. Elbow-length gloves were worn for manual stirring and debris removal from
the HIPEC tubing ports.

In cases of ovarian carcinoma, cisplatin was used as a chemotherapeutic drug in HITAC. Apart from
routine drug dosage calculation using body surface area, another method of estimation uses the