Anatomy - diagnostic laparoscopy for adhesion zone, lavage cytology, biopsy sampling, second look operation

The Sugarbaker Index, also known as the Peritoneal Cancer Index (PCI), is a scoring system used to determine the tumor burden and distribution in peritoneal carcinomatosis. The PCI divides the abdominal cavity into 13 regions, of which 9 are abdominal and 4 are enteric areas.

Abdominal regions

0. Central abdomen

1. Right upper quadrant

2. Epigastrium

3. Left upper quadrant

4. Left flank

5. Left lower quadrant

6. Pelvis

7. Right lower quadrant

8. Right flank

Enteric regions:

9. Upper jejunum

10. Lower jejunum

11. Upper ileum

12. Lower ileum

In each of these 13 regions, the size of the largest tumor deposit is assessed and scored as follows:

- 0 = No visible tumor deposits

- 1 = Tumor deposits up to 0.5 cm

- 2 = Tumor deposits 0.5 - 5 cm

- 3 = Tumor deposits > 5 cm or confluence

The scores of all 13 regions are then summed to a total score (PCI 0-39), reflecting the extent of peritoneal carcinomatosis.

Greater omentum: The greater omentum is a large, apron-like peritoneal fold that hangs down from the greater curvature of the stomach and covers the transverse colon as well as parts of the small intestine loops. It contains abundant adipose tissue, lymph nodes, and blood vessels and plays an important role in immune defense as well as in isolating infections within the abdominal cavity.

Transverse colon: The transverse section of the large intestine that runs between the right and left colic flexures. It is located intraperitoneally and is supplied by the transverse mesocolon. The transverse colon is responsible for water absorption and the transmission of intestinal contents to the descending colon.

Surfaces of the right liver lobe: The right liver lobe is the largest and functionally most important part of the liver, located in the right upper abdomen. It borders the diaphragm and partially covers the right kidney. The liver plays a central role in metabolism, detoxification, and bile production.

Underside of the right diaphragm: This structure represents the muscle-tendon plate that separates the abdominal cavity from the thoracic cavity. The right diaphragm is higher than the left and directly borders the right liver lobe. It is involved in respiration by contracting and enlarging the chest cavity.

Right retrohepatic space: Also known as Morison's pouch, this is a potential space between the right liver surface and the right kidney, clinically significant because fluid can accumulate here in cases of ascites or bleeding.

Epigastric fat pad: The adipose tissue in the epigastric region is subcutaneous and protects the underlying organs. It also serves as an energy reserve and insulation.

Left lobe of the liver: This smaller part of the liver is located in the left upper abdomen and extends across the midline. It is separated from the right lobe by the falciform ligament. The left lobe is anatomically smaller but functionally just as important as the right.

Lesser omentum: The lesser omentum is a smaller peritoneal fold that connects the liver with the lesser curvature of the stomach and the proximal duodenum. It forms the anterior wall of the omental bursa and contains important structures such as the portal vein, the proper hepatic artery, and the common bile duct.

Falciform ligament: This structure is a connective tissue attachment that secures the liver to the anterior abdominal wall and the diaphragm. It divides the liver into a right and left lobe and contains the ligamentum teres hepatis, a remnant of the fetal umbilical vein.

Underside of the left diaphragm: This region includes the left diaphragm dome, which separates the left pleural field and the left lung from the abdominal organs such as the spleen and the stomach.

Spleen: The spleen is a highly vascular, intraperitoneal organ located in the left upper abdomen beneath the diaphragm. It has important functions in immune defense, blood filtration, and the breakdown of old or damaged erythrocytes.

Tail of the pancreas: The tail of the pancreas is located in the left upper abdomen and extends to the splenic hilum. The pancreatic tail is an endocrine and exocrine organ that produces insulin and digestive enzymes.

Anterior and posterior surfaces of the stomach: The stomach is located in the left upper abdomen and consists of various sections such as the fundus, corpus, and antrum. It is covered by the peritoneum and the omentum from the anterior and posterior abdominal wall. The stomach is essential for the mechanical and chemical digestion of food.