1. Procedure
1.1. Insertion of cannulas (S/A1)
1.1.1. 4 Incisions for cannula insert (S/A1)
1.1.1.1. Using a scapel (S)
1.1.2. Using tongue to pull through the subcutaneous tissue (S)
1.1.3. Two Inflow Cannulas
1.1.3.1. Smaller tubes
1.1.3.2. From the upper region to lower region(pelvis)
1.1.4. Two Outflow Cannulas
1.1.4.1. Larger tubes
1.1.4.2. From the lower region to upper region(above liver and stomache)
1.1.4.3. Tip covered with catheters
1.1.4.3.1. Prevent fat/small intestine from sticking
1.1.5. Inserted surgeon side first and then the assistant side (S)
1.2. Closure of abdominal cavity (S/A1)
1.2.1. water tight
1.2.2. Suture of the abdomen and 4 incision sites
1.3. Perfusion
1.3.1. Inflow tubing connected
1.3.2. Saline perfusate flushed into abdominal cavity
1.3.3. Machine heats Inflow of 41 C and outflow of 39.5 C
1.3.3.1. Mitomycin C
1.3.4. Surgeon continuously shakes the abdomen
1.3.4.1. distribute throughout all peroneal surfaces
1.3.5. Perfusion of chemotherpeutic fluid for 2 hours
1.4. Removal of fluid and cannulas
1.4.1. Open from top to bottom
1.4.2. Excess fluid suctioned out
1.4.3. Catheter and outflow cannula removed
1.4.4. Inflow cannula removed
1.4.5. tubings disposed in biohazard bags (S)
1.4.6. inspected for any bleeding (S)
1.5. Closure of wound
1.5.1. abdominal wall fascia closure(musculature closure) (S/A1)
1.5.2. subcutaneous fat sutured (S/A1)
1.5.3. Skin stapled
1.5.4. negative pressure dressing placed
2. People
2.1. Patient
2.1.1. located in the middle on the bed
2.1.2. Middle aged woman with metastatic appendiceal cancer
2.1.3. already underwent cytoreduction
2.2. Surgeon
2.2.1. located to the right side of the patient abdomen
2.2.2. mainly performs the HIPEC surgery
2.3. Assistant 1
2.3.1. located to the left side of the patient abdomen
2.3.2. assists the HIPEC surgery
2.4. Assistant 2
2.4.1. located to the lower side of the patient abdomen
2.4.2. secondarily assists the HIPEC surgery
2.5. Perfusionists
2.5.1. located to the upper side of the patient
2.5.2. operates perfusion machine
3. Environment
3.1. Patient Bed
3.2. Perfusion Machine
3.3. Protective Covers
4. Unmet Need
4.1. 5 lesion sites
4.1.1. 4 for cannulas
4.1.2. 1 from debulking
4.2. Frequent reopening and closing of main lesion site
4.2.1. Opened for debulking
4.2.1.1. Closed for perfusion
4.2.1.1.1. Opened for removal
5. Recommendation
5.1. 5 Lesion sites => Single Lesion site
5.1.1. Place y-shaped cannulas on debulking lesion site
5.1.1.1. reduces suture time
5.2. Frequent reopening => partial suturing
5.2.1. Partially suture different layers
5.2.1.1. reduced infection rate
6. Product
6.1. Perfusion Machine
6.1.1. Cannulas
6.1.2. Temp
6.1.3. Pump
6.1.4. Heater