Laparoscopic hepatic artery infusion pump placement

Patients with metastatic colorectal cancer limited to the liver are candida tes for regional chemotherapy with implantable hepatic artery infusion (HAI ) pumps. The poor prognosis of these patients, and the requirement of a lap arotomy for placement, has deterred many oncologists from referral for HAI pump implantation. Minimally invasive surgical techniques are particularly well suited for the task of HAI pump placement in patients who may not tole rate the additional physiologic stress of a major surgical intervention. Ad vances in laparoscopic techniques allow pumps to be implanted safely and ef fectively, replicating the well-described tenets of open pump placement. Th e principal steps of the operation include a thorough laparoscopic evaluati on to exclude extrahepatic disease, complete vascular isolation of the hepa tic and gastroduodenal arteries, ligation of aberrant hepatic vessels, secu re cannulation of the gastroduodenal artery, and confirmation of complete h epatic perfusion without extrahepatic perfusion. We describe the procedure and briefly review our clinical experience. We believe that the benefits ty pically derived from minimally invasive approaches (less pain, fewer periop erative complications, shorter hospitalization, faster recovery, and potent ially less immune suppression) will be seen in these patients as well. If s o, a completely laparoscopic approach to regional treatment of the liver ma y extend survival and improve the quality of life of patients whose prognos is is poor regardless of treatment. Controlled trials will be required to e valuate the added value of a laparoscopic approach to the placement of the hepatic artery pump.