1. Introduction
As of 2017, there have been 232,255 cases of domestic cancer incidence, with an estimated cancer incidence rate of approximately 1,867,405 [
1]. Therefore, approximately 3.6% of patients were diagnosed with cancer, which was the leading cause of death among men and women in 2018 [
2]. After cancer surgery, a high probability of recurrence (within 5 years) at more than 50% exists due to the residual tumor tissue.
Chemotherapy is administered concurrently to reduce the chance of recurrence. However, due to its side effects, patients experience difficulties during treatment. Thus, new treatment methods for eliminating the probability of recurrence within 5 years have been studied and are currently being used in many medical institutions [
1,
2,
3,
4,
5,
6]. Most of the thermal death methods for tumors include HIFU (High-Intensity Frequency Ultrasonic) treatment, laser treatment, and radiofrequency treatment [
3,
4,
5,
6]. Among them, the high-frequency treatment causes hyperthermia by an antenna that heats through radio and microwave radiation and damages cancer cells with heat.
In particular, HIFU can be applied to targeted therapy and can necrotize tumors using high heat [
7]. This method can destroy cancer cells by generating immediate heat. However, it has the side effect of damaging the skin and its surrounding tissues [
7]. Laser treatment causes a chemical reaction between light and oxygen to generate instant heat [
8]. This method damages the micro-vessels around cancer cells to minimize patient pain and block the supply of nutrients to cancer tissue. These treatments cause side effects such as skin hypersensitivity, edema, pain, and pigmentation [
9]. Laser treatment can also damage the skin [
8,
9].
Radiofrequency treatment is a method for irradiating cancer tissue with electromagnetic waves to generate heat, increase the metabolic rate in the body, and suppress the proliferation of cancer cells to destroy them [
10]. Therefore, the radiofrequency treatment has no side effects such as nausea, vomiting, anorexia, weight loss, digestive disorders, and hair loss. Nevertheless, red spots may occur on the skin tissue where the electrodes are attached, and side effects such as slight burns, scars, inflammation, and lumps may occur in the fat layer [
10,
11].
In addition, HIFU therapy, laser therapy, radiofrequency therapy, and radiation therapy methods are used for the targeted treatment of tumors and are often used in combination with chemotherapy to increase the effectiveness of treatment. Chemotherapy is administered intravenously; however, various treatment systems that allow for the direct exposure of anticancer drugs are currently under investigation and development.
Among them, hyperthermic intraventricular chemotherapy (HIPEC) surgery is a system that uses high-temperature anticancer drugs and injects them into the abdominal cavity, and it is a treatment method that directly exposes anticancer drugs to residual tumors after surgical operation. Hyperthermia using high-temperature anticancer drugs has been shown to be highly effective against cancer cells when administered at temperatures ranging from 41 °C to 43 °C Celsius, whereas normal tissues can be damaged by temperatures above 46 °C Celsius [
12,
13,
14]. This hyperthermia increases the sensitivity of cancer to chemotherapy by increasing the penetration of chemotherapy on the peritoneal surface and impairing DNA repair. In addition, hyperthermia has direct cytotoxic effects by inducing apoptosis, activating heat shock proteins that act as receptors for natural necrotic cells, inhibiting angiogenesis, and promoting protein denaturation [
15]. The problem with these cancers is that the 5-year survival rate is difficult to expect, and the risk of recurrence is high; therefore, the purpose of HIPEC surgery is to completely remove the remaining cancer cells. The 5-year survival rate of gastric cancer patients undergoing HIPEC surgery increased by more than 61% compared to patients undergoing laparoscopic surgery [
16,
17,
18,
19]. Similarly, the 5-year survival rate of peritoneal cancer patients increased by over 48.5% compared to those undergoing laparoscopic surgery. Following colon cancer surgery, patients who received chemotherapy had a 41% recurrence rate at the 5-year survival mark due to peritoneal metastasis [
20]. However, HIPEC surgery resulted in a 53% reduction in its recurrence rate at the 5-year survival rate.
However, if a 41 °C to 43 °C medication is injected into the abdominal cavity while using a hyperthermia system in the operating room, the intraperitoneal temperature is lowered to below 41 °C, and the therapeutic effect of hyperthermia cannot be enhanced [
12].
In this study, when administering high-temperature medications in the abdominal cavity, the thermal compensation based on the temperature measurement could maintain the temperature of the drug at 41–43 °C by monitoring the temperature state of the drug and actively increasing the heat when the temperature decreased. Moreover, we developed the control method design.
A control signal was generated to compensate for the temperature difference in the look-up table (LUT) module by comparing the temperature of the drug flowing out and the reference heat ranging from 41 °C to 43 °C. Hence, this study presents a method that compensates for heat according to the control signal.
3. Experimental Results
For the performance test of the substance temperature maintenance, we conducted an experiment that comprised the proposed module, beaker, thermal imaging camera, and temperature measuring device, as shown in
Figure 7. This study was not a clinical trial but an experiment to test the performance of the module and evaluate whether the heat temperature could be accurately controlled. Therefore, we aimed to obtain results on the accuracy, reproducibility, and performance reliability of temperature control. Additionally, the performance test evaluation to minimize the response error (delay) for control was reviewed.
The peritoneal cavity could be substituted with a beaker (100 mL) when filled with normal saline (40 cc). The temperature range of normal saline is 41–43 °C; if this was below 41 °C or above 43 °C, the TC and LUT were operated and controlled to match this range. Thus, it was simulated similarly to the HIPEC surgical procedure.
The designed temperature control module and the beaker were connected with a catheter, as shown in
Figure 7, and the catheter functioned as the inflow and outflow of the beaker. An external monitoring system measured the temperature conditions and thermal compensation adjustments.
The system determined the pulse signals according to the current drug temperature to reduce, increase, or maintain the temperature. In temperature tests, the pulse signal range of
Tref was stably maintained in the range of 41–43 °C, as shown in
Figure 8. If the temperature of the signal
To was reduced to 41 °C or less, the pulse signal of the different output from the TC was set to transmit to the LUT. Thus, the LUT generated a command signal (
ord) for the
Tp signal and took measures to heat it in the heat exchanger.
The proposed module configured
Tref and
To signals before their input to TC. The TC-
Tdif output worked to output a pulse signal for the drug temperature state. As shown in
Figure 8 and
Figure 9, when the pulse signal (
Tdif =
Tref =
To) corresponding to the range of
Tdif from 41 °C to 43 °C was output, the output pulse signal was 1. At this time, as shown in
Figure 8, the signal of 1 was in the form of a pulse corresponding to 4 to 5 μs. If the
Tdif (
Tdif =
To/
Tref) signal output from the TC was below 41 °C, the pulse signal of
Tdif corresponded to 1, and this pulse signal corresponded to a period of 2–4 μs. If the signal output from the TC
Tdif (
Tdif =
To/
Tref) corresponded to 44 °C or higher, the pulse was 0. The period of this signal is 1–2 μs. The signal output by
Tdif (
Tdif =
To/
Tref) in TC was a pulse signal of 1 corresponding to 46 °C or higher, and the period of this pulse signal corresponded to 7–8 μs. Therefore, the pulse signal of 1 (4–5 μs) generated from
Tdif was delivered to the LUT, and the LUT generated a
Ts signal (41–43 °C); therefore, the substance was injected into the abdominal cavity without being transmitted to the heat exchanger.
The pulse signal corresponding to 1 (2–4 μs) and generated from Tdif was delivered to the LUT. The LUT generated a Tp signal (<41 °C). The Tp signal provided the heat exchanger with a command signal for heating to maintain a temperature range of 41 °C to 43 °C. The pulse signal of 0 (1–2 μs) generated from Tdif was delivered to the LUT. The LUT generates a Ta signal (>44 °C). The Ta signal delivers a command signal for cooling to maintain a temperature from 41 °C to 43 °C in the heat exchanger.
The pulse signal of 1 (7–8 μs) generated from Tdif was delivered to the LUT, and the LUT generated a Tx signal (>46 °C), which transmitted the Tx signal to the heat exchanger. Therefore, the system operation was stopped until the intraperitoneal injection temperature range changed from 41 °C to 43 °C. Therefore, the command signal data transmitted from the LUT to the heat exchanger were Tp, Ts, Ta, and Tx.
More specifically, if the logical function of the D-flip flop was considered in the experiment, the control process of TC and data learning of LUT was added to the heat exchanger using a binary signal and based on a pulse waveform. Therefore, the temperature of the drug in the heat exchanger could be controlled, as shown in
Figure 9 and
Figure 10. If
Tref always maintains a constant value in the range of 41—43 °C (
Tref = 0), the range of the temperature of the medicinal substance (
Tdif) flowing out of the beaker (peritoneal cavity) is 41—43 °C (T
o = 0), as shown in
Figure 10. At this point, the temperature difference (
Tdif =
To =
Tref) generated in the comparator could provide a value of 1. Thus, the temperature of the substance in the heat exchanger remained unchanged, and the temperature range of T
dif was between 41 °C and 43 °C. In the experimental process of the temperature difference generation for the TC output,
Tref and
To were assumed to be 38 °C (
To = 0) and 41 °C (
Tref = 1), respectively, and then these two pulse signals were set to be input to TC. The output (
Tdif) of the TC generated a pulse signal (
Tdif = random signal) in which a temperature difference of 3 °C occurred. When these signals were input to the LUT, the LUT recognized a temperature difference of 3 °C. The LUT, which recognized a temperature difference of 3 °C, generated a command signal (
ord) of
Tp in the output. This command signal (
ord) could be input to the heat exchanger, which heat unless at least 3 °C to reach 41 °C.
It can be noted that
Ta,
Tp,
Ts, and
Tx were accurately output when the pulse waveform signals corresponding to 41 and 43 °C were periodically generated in
Tref. When
Tref and
To were compared in the D-flip flop, the signal generated from
Tdif could minimize the delay signal (
T1 and
T2), as shown in
Figure 11. Therefore, the signal (
T(t)) generated from
Tdif could generate an accurate signal without an error, as shown in Equation (3) [
25].
Here,
T(t) represents the period of the delay signal for the difference between
T1 and
T2, and
Tr represents the theoretical minimum delay time. As shown in
Figure 11,
T1 and
T2 generated 209 ns each, and
Tr generated 4.18 ps. Moreover, the error for the delay time of the module was within 1.8%. Therefore, the accuracy, reliability, and reproducibility of the module’s operation had a high level of 98.2%, respectively.
The control performance (inflow, outflow, and feedback) was tested by connecting the designed module to a beaker.
Figure 12a presents an image that was obtained using a thermal imaging camera for the thermal temperature state of normal saline inside the beaker. We also evaluated the correctness of signals
Ta,
Tp,
Ts, and
Tx obtained from the LUT through thermal imaging, confirming that the temperature of the drug was maintained in the therapeutic range by the system. Additionally, the thermal temperature distribution signal for the thermal temperature control performance according to the pulse waveform is shown in
Figure 12b,c. The results show that, over time, the heat temperature control of the heat exchanger was well-adjusted so that it could be properly maintained.
When the
Tdif signal was generated from the TC, the LUT provided
Ta,
Tp,
Ts, and
Tx signals to control the temperature of the heat exchanger (shown in
Figure 13) and supply constant heat from the heat exchanger during time changes. By performing the interlocking function of TC and LUT, the heat distribution graph showed that the control system maintained its temperature within the desired range. Therefore, this result confirmed that the operation was suitable for HIPEC’s surgical treatment.
Finally,
Figure 14 shows the connected circuits that were configured to verify the proposed design method for the three-dimensional (3D) printer, the PCB (printed circuit board) board, and the motor, and evaluates whether the temperature was controlled using a temperature sensor, monitor device, and thermal imaging camera. For the operation of the evaluation, the supplementary version of this discussion can be referred to, and when the temperature fell below 41 °C (
Tp) in the equipment, the control system automatically raised the heat to reach the range of 41–43 °C (
Ts). If the heat reached between 44 °C and 46 °C (
Ta), the control system automatically stopped the operation (
Tx) and then adjusted to stay at 41 °C to 43 °C (
Ts). Therefore, the measurement results were consistent with the experimental (see
Figure 13) and simulation results (see
Figure 7,
Figure 8,
Figure 9,
Figure 10,
Figure 11,
Figure 12 and
Figure 13). When operating for 120 min in the control system so that the temperature could reach a stable temperature (
Ts) at a range between 41 °C and 43 °C [
15,
21,
22,
23,
24] and a heat temperature of 42 °C after 5 min in the temperature meter. This was measured, and after 50 min, a 43 °C measurement result was obtained from the thermal imaging camera. When considering the operation time of 120 min [
15,
21,
22,
23,
24], the measurement results were analyzed to be controllable in a sufficiently stable state.
4. Discussion
In current surgical procedures, the HIPEC treatment method manually controls the temperature with an assistant. If the heat rises, it starts to lower the heat; if the heat decreases, the assistant manually adjusts to increase the heat. In addition, if the fever is constant, the system is on standby; if the fever starts to decrease or increase, the treatment has to stop until the proper temperature is maintained. Therefore, the treatment process is cumbersome and time-consuming. However, this study has the advantage of automatically adjusting the heat through temperature monitoring to solve the complicated process. When comparing and judging temperatures and transmitting the provided data to the LUT to generate a command signal, the reaction speed was the crucial parameter. As the reaction speed increased, the operational error decreased. Moreover, the reaction speed is an essential factor because it is related to the accuracy and reliability of the system. In this regard, the proposed system has a high response speed and high reliability. The designed system can also be evaluated by experimenting with animals. However, our experiment of the designed system focused on maintaining the heat in the heat exchanger (41–43 °C) and evaluating the accuracy and reliability of the compensation function through comparison, judgment, LUT data learning, and the generation of a light signal by sensing heat. Note that evaluating the accuracy and reliability of the compensation function is paramount. More specifically, when the temperature is too low or too high, the pulse signal conversion timing for the comparison and discrimination to reach the treatment temperature range (41–43 °C) through the TC control is considered to be very important. The reason for this is that the comparison and judgment speed for the control can be related to the performance of TC’s control speed. Therefore, the fast operation of the heat exchanger by sending a command signal (
ord) to the LUT through a quick comparison and judgment of the TC is related to the operation time. The operation time was 90–120 min in total, and during that time, it was very important to reduce the delay time of the signal response characteristics to increase the patient’s treatment performance through rapid control and circulation. Thus, the experiments and functional tests used a beaker and a thermal imaging camera, which were considered appropriate methods to evaluate the proposed system. Nevertheless, animal experiments are necessary for commercialization in the future. As shown in
Table 2, the proposed method is estimated to be 51 times faster than previously studied methods, considering the system response speed. The data for the comparison and judgment obtained in this study included binary signals detecting heat. The cases studied in
Table 2 are modules designed for error correction through comparison, judgment, and feedback on binary signals rather than a system for thermal treatment. Consequently, the important part of these modules was the response speed of the signal. Hence, improving the response speed is significant for comparison and judgment. In
Table 2, the response speed of the proposed system outperforms that of the response speed in the existing literature. As shown in
Figure 11,
T1 and
T2 generated 209 ns each, and T
r generated 4.18 ps. The reason for this is that
T1 and
T2 should be theoretically reached within 1 μs (
Tr = 1 μs), but according to cases announced in 2021, their delay time was within 225 ns to 73 μs. Thus, the smaller the delay time, the better the module’s performance, allowing it to become superior [
26,
27,
28,
29,
30,
31]. In particular, the error for the delay time of the module was 1.8% compared to the delay time in [
26], which could reach the 98.2% level for the accuracy, reliability, and reproducibility of the module [
32,
33].
5. Conclusions
In this paper, a control system was proposed to maintain and compensate the treatment temperature in HIPEC surgery using high-temperature drugs for ovarian cancer surgery.
The small tumor tissue remaining after ovarian cancer surgery is difficult to treat surgically. Therefore, the method proposed in this study can increase the therapeutic effect of hyperthermia chemotherapy by injecting and circulating the drug in the abdominal cavity and keeping the treatment temperature constant. In addition, by preventing the temperature from rising above a certain point, it can reduce the side effects caused by damage to normal tissues.
During the treatment, the temperature of the medicinal substances should always be constant; however, the fever may be lowered because the drug circulates through and outside the body. Conversely, heat may increase. Therefore, if the heat is manually controlled by monitoring the temperature from the outside, this process has the disadvantage of interfering with the treatment. However, the advantage of our study is that the heat can be automatically reduced through external monitoring. Alternatively, the heat can be automatically increased. Additionally, the proposed system can retain heat and has an automatic control function. The method for maintaining/compensating for the temperature through heat comparison/determination, data collection/learning of the LUT, and the control signal output is considered a crucial and groundbreaking technology. Further, the response time for the proper control and comparison, and judgment of heat was substantially short in the feedback process because the time required for comparison and judgment was minimal. Moreover, the system had a low margin of error (within 1.8%) and high accuracy (98.2%). The application of this technology can eliminate errors in manual methods controlled by humans and guarantee accurate, safe treatment and rapid surgery. In conclusion, the proposed system has good application prospects and could be applied to the field of surgery, obstetrics, and gynecology.