Transthoracic radiofrequency ablation for hepatic tumor located beneath the diaphragm under one-lung ventilation: A case report.

RATIONALE

Radiofrequency ablation (RFA) has become the reliable, effective, and less invasive treatment for small primary or metastatic hepatic tumors. Hepatic tumors that located immediately beneath the diaphragm are difficult to treat with percutaneous RFA due to poor visualization by percutaneous ultrasonography and the close location of the heart or lung. A transthoracic approach has been proposed to be an alternative for hepatic tumors located beneath the diaphragm that are difficult to access by conventional percutaneous or laparoscopic approaches. There has been no report regarding the anesthetic management of the transthoracic RFA for hepatic tumor.

PATIENT CONCERNS

A 69-year-old female had undergone segmentectomy due to hepatocellular carcinoma 4 years ago.

DIAGNOSES

Newly developed hepatic tumor located in the liver dome and beneath the diaphragm was diagnosed by follow-up imaging study.

INTERVENTIONS

Because the tumor could not be identified by transabdominal ultrasonography (US), transthoracic approach for RFA under one-lung ventilation was planned. General anesthesia was induced with propofol and remifentanil via target-controlled infusion system and rocuronium was administered. Orotracheal intubation with double-lumen endotracheal tube was performed and position of the tube in the trachea was confirmed by bronchoscope. The RFA electrode was introduced percutaneously into the right pleural cavity, guided by visualization through the thoracoscope and inserted into the tumor after visualizing the tumor by US. Radiofrequency waves can be successfully administered through the needle.

OUTCOMES

We performed successfully RFA of the hepatic tumor through one-lung ventilation and transthoracic approach. At 5 days postoperatively, she was discharged in a stable condition without any complication.

LESSONS

Transthoracic RFA can be successfully performed under one-lung ventilation, optimal analgesia, and vigilant monitoring.