Figure 4.

Schematic diagram of an open HIPEC procedure, with one inflow catheter and three outflow drains. The abdominal wall is retracted by sutures attached to a Thompson retractor (1). A plastic sheet is placed over the open abdomen (2) and an incision is made in the plastic to enable access to the abdominal contents. The heated carrier solution is stored in the reservoir (3) and is circulated by a roller pump (4). The inflow perfusate passes to a heat exchanger (5) to heat the solution to the required temperature. The temperatures are monitored during the treatment (6), usually in the left-subphrenic area, right-subphrenic area, pelvic area near the outflow drains, and in or near the inflow catheter. The smoke evacuator (7) is placed under the plastic sheet to prevent the aerosolization of chemotherapy.