PIPAC can only be applied by laparoscopy. The fumigation as a gas allows a homogeneous dispersion of chemotherapy within the peritoneal cavity or pleural cavity. The administration of chemotherapy under pressure increases the local tissue penetration of the chemotherapy allowing high concentrations in cancer cells. The procedure is performed under general anesthesia. Two trocars or tubes are inserted via two small incisions (5-12 mm) into the peritoneal cavity. Carbon dioxide insufflation grants the necessary workspace. First, small tissue samples of the tumor knots are retrieved (biopsy). Then, the chemotherapy is dispersed as pressurized aerosol inside the abdominal or chest cavity for 30 minutes. At the end of the procedure, the pressure is released and the gas aspirated, and the skin incisions are closed.
The whole procedure lasts about 90 minutes. The length of hospital stay is usually 3-4 days. Three applications of PIPAC or PITAC are recommended within 3 months with a delay between the applications: 4-6 weeks. Alternatively, this can be interspersed with chemotherapy between every second cycle. All patients are observed closely during the therapeutic cycle.