Tumor cell distribution following laparoscopic colectomy in a porcine model

PURPOSE: A clinically relevant, laparoscopic colectomy model has been developed to quantify surgical practices that may affect the incidence of port wound tumor implantation. METHODS: Suspended Cr-51-labeled, fixed HeLa cells were injected intraperitoneally into pigs before laparoscopic colectomies were performed with or without insufflation. Tumor cell contamination of instruments, ports, stability threads, and excised port wound margins was determined by gamma counting. RESULTS: Tumor cells were distributed throughout the peritoneal cavity, and the number detected at wound sites was directly related to number injected. Ports used by the operating surgeon had more cells than those used by the camera operator or assistant surgeon. Postoperative withdrawal of contaminated ports through abdominal wound was associated with an increase in port site contamination. Although the port site distribution of tumor cells was affected, mechanical elevation of abdominal wall did not eliminate contamination at any site. CONCLUSION: These results demonstrate application of the porcine model to test current surgical practices and measures that might be used perioperatively to reduce the numbers of intraperitoneal tumor cells or their distribution to specific sites during laparoscopic or open surgery.