Advancements in nebulizers for pressurized intraperitoneal aerosol chemotherapy (PIPAC)

Introduction: Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is an innovative intraperitoneal drug delivery technique utilizing a nebulizer to aerosolize liquid chemotherapy agents under pressure, distributing them evenly throughout the peritoneal cavity to achieve therapeutic effects. As increasing clinical evidence supports the safety and efficacy of PIPAC as a promising treatment for peritoneal metastasis, optimizing nebulizer technology to enhance treatment outcomes has garnered significant research interest. Content: Following initial investigations into the internal structure, mechanical properties, and optimization parameters of the original PIPAC nebulizer, researchers worldwide have focused on refining nebulizer design and exploring innovative applications of aerosolization devices, resulting in the development of several clinically applicable nebulizers with distinct characteristics. Summary: This review aims to provide a comprehensive examination of the global advancements in PIPAC nebulizer development, the nebulizer alternative devices, evaluation parameters and methods, as well as future research directions, aiming to inform the development, optimization, and application of novel nebulizers for PIPAC, thereby contributing to the advancement of this promising therapeutic approach. Outlook: Current methods for evaluating nebulizer performance are continually being refined, and the integration of nebulizers with other physical modalities holds great promise for further improving PIPAC outcomes.