Schumacher Guido, Eisele Robert, Spinelli Antonino, Schmidt Sven Christian, Jacob Dietmar, Pratschke Johann, Neuhaus Peter
Department of General, Visceral, and Transplantation Surgery, Charité Campus Virchow Klinikum, Berlin, Germany.
J Laparoendosc Adv Surg Tech A. 2007 Apr;17(2):153-9. doi: 10.1089/lap.2006.0001.
Radiofrequency ablation has established itself as the preferred treatment for irresectable liver tumors. It can be performed either percutaneously, laparoscopically, or by open surgery. The choice of approach depends on the patient and tumor-related variables. The laparoscopic approach appears to be the safest and most effective method for small tumors on the liver surface. It also provides additional information on the intrahepatic tumor burden with the use of intraoperative ultrasound and staging laparoscopy. Furthermore, the pneumoperitoneum reduces the flow of the portal vein and increases the efficacy of the ablation. Depending on the location of the tumor, mobilization of the liver or lysis of adhesions from previous surgery can require open surgery. Our aim was to study the combined use of laparoscopy and laparotomy by using hand-assisted laparoscopic radiofrequency ablation.
We performed hand-assisted laparoscopy to ablate nine tumors in seven patients, enabling us to combine most of the advantages of laparoscopy and open surgery. The radiofrequency ablation was technically simple to perform. A laparoscopy of the entire abdominal cavity and a thorough examination of the entire liver via ultrasound was also performed.
The electrode was accurately placed in all patients. In four patients, a complete mobilization of the right lobe was performed to obtain the easiest possible access to the tumor. In three patients, severe adhesions from previous surgeries were removed prior to insertion of the laparoscopic tools. The ablation was completed safely and successfully in all patients.
Our overall impression of the hand-assisted laparoscopic approach is that it seems to have a major advantage in comparison with simple laparoscopy, specifically for adhesions from previous surgeries and when the right liver lobe requires mobilization. Also, needle placement seems to be far more accurate than with simple laparoscopy.
射频消融已成为不可切除肝肿瘤的首选治疗方法。它可以经皮、腹腔镜或开放手术进行。治疗方法的选择取决于患者和肿瘤相关变量。对于位于肝表面的小肿瘤，腹腔镜方法似乎是最安全、最有效的方法。它还可通过术中超声和分期腹腔镜检查提供有关肝内肿瘤负荷的额外信息。此外，气腹可减少门静脉血流并提高消融效果。根据肿瘤位置，可能需要开放手术来游离肝脏或松解既往手术造成的粘连。我们的目的是通过手辅助腹腔镜射频消融研究腹腔镜和剖腹手术的联合应用。
我们对7例患者的9个肿瘤进行了手辅助腹腔镜消融，使我们能够结合腹腔镜和开放手术的大部分优点。射频消融在技术上操作简单。还对整个腹腔进行了腹腔镜检查，并通过超声对整个肝脏进行了全面检查。
所有患者电极均准确放置。4例患者对右叶进行了完全游离，以便最轻松地接近肿瘤。3例患者在插入腹腔镜器械前清除了既往手术造成的严重粘连。所有患者均安全、成功地完成了消融。
我们对手辅助腹腔镜方法的总体印象是，与单纯腹腔镜相比，它似乎具有主要优势，特别是对于既往手术造成的粘连以及需要游离右肝叶的情况。此外，针的放置似乎比单纯腹腔镜更准确。
