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Pressurized intraperitoneal aerosol chemotherapy (PIPAC). The procedure is performed in an operating room equipped with laminar air-flow and is remote-controlled. In a first step, a normothermic capnoperitoneum is established with a pressure of 12 mmHg at body temperature. A chemotherapy solution (about 10 % of a normal systemic dose) is nebulized with a micropump into the tightly closed abdominal cavity, and maintained for 30 min. The toxic aerosol is then exhausted through a closed system and released into the external environment
i) The 12-mm trocar was placed in the umbilicus of the pig and inflated with CO2 gas. Pneumoperitoneum was created and the intraabdominal pressure was maintained below 12 mmHg.
ii) Two additional ports were placed.
iii) The liver and gallbladder were identified under white light, and the gallbladder was pulled to the peritoneum.
iv) Five millimeters of SF solution was infused directly into the gallbladder. A small bile leak from the infused site was identified and clipped.
v) The biliary structures were observed under blue light emitted from an LED light source.
vi) The pig was euthanized at the end of the procedures.