Endocrinology and Metabolism Institute, Cleveland Clinic, 9500 Euclid Avenue/F20, Cleveland, OH 44195, USA.
Surg Endosc. 2011 Apr;25(4):1143-7. doi: 10.1007/s00464-010-1330-5. Epub 2010 Sep 16.
Although radiofrequency-assisted (RF) precoagulation has been described for open resections, there is little data evaluating precoagulation options in laparoscopic liver resection. The purpose of this study is to provide an algorithm for the use of monopolar and bipolar RF devices in laparoscopic liver resection.
Patients undergoing laparoscopic liver resection utilizing precoagulation during the period 2007-2009 were identified from a prospectively maintained, institutional review board-approved database. RF-assisted precoagulation was performed using a second-generation monopolar RF ablation catheter (Starburst XL, AngioDynamics) or bipolar RF device (Habib 4X, AngioDynamics).
Precoagulation was utilized in 31cases (monopolar, n = 19, and bipolar, n = 12). Procedures performed included segmentectomy/wedge resection in 19 patients and bisegmentectomy in 12 patients. The bipolar RF device was used for left lateral sectionectomies (90%) in which there was linear transaction, whereas the monopolar RF catheter was used for nonlinear segmental and wedge resections involving the right lobe (95%). Time required for precoagulation was 22.5 ± 7.2 min for the bipolar and 33.6 ± 15.9 min for the monopolar device. No patient developed postoperative bleeding, bile duct injury, or liver abscess. At follow-up, one patient in the monopolar group developed a suspected local recurrence.
We have suggested an algorithm to select a given device based on tumor location and type of resection. With approximately 30 min of time spent for precoagulation, the blood loss and rate of local recurrence were favorable. There also could be an oncologic benefit due to additional functional margin obtained with the RF effect.
虽然射频辅助（RF）预凝已被描述用于开放性切除术，但在腹腔镜肝切除术中评估预凝方案的数据很少。本研究的目的是提供一种在腹腔镜肝切除术中使用单极和双极 RF 设备的算法。
从一个前瞻性维护的机构审查委员会批准的数据库中确定了在 2007 年至 2009 年期间接受腹腔镜肝切除并使用预凝的患者。使用第二代单极 RF 消融导管（Starburst XL，AngioDynamics）或双极 RF 设备（Habib 4X，AngioDynamics）进行 RF 辅助预凝。
在 31 例患者中使用了预凝（单极，n=19，双极，n=12）。进行的手术包括节段切除术/楔形切除术 19 例，双节段切除术 12 例。双极 RF 设备用于左外侧叶切除术（90%），其中存在线性切除，而单极 RF 导管用于涉及右叶的非线性节段和楔形切除术（95%）。双极 RF 设备的预凝时间为 22.5±7.2 分钟，单极 RF 导管的预凝时间为 33.6±15.9 分钟。无患者发生术后出血、胆管损伤或肝脓肿。随访时，单极组的 1 例患者疑似局部复发。
我们提出了一种根据肿瘤位置和切除类型选择特定设备的算法。预凝时间约为 30 分钟，出血量和局部复发率均较好。由于 RF 效应获得了额外的功能边界，因此可能具有肿瘤学益处。
