Laparoscopic radiofrequency ablation of neuroendocrine liver metastases

We previously reported on the safety and efficacy of laparoscopic radiofrequency thermal ablation (RFA) for treating hepatic neuroendocrine metastases. The aim of this study is to report our 5-year RFA experience in the treatment of these challenging group of patients. Of the 222 patients with 803 liver primary and secondary tumors undergoing laparoscopic RFA between January 1996 and August 2001, a total of 34 patients with 234 tumors had neuroendocrine liver metastases. There were 25 men and 9 women with a mean ± SEM age of 52 ± 2 years who underwent 42 ablations. Primary tumor types included carcinoid tumor in 18 patients, medullary thyroid cancer in 7, secreting islet cell tumor in 5, and nonsecreting islet cell tumor in 4. There was no mortality, and the morbidity was 5%. The mean hospital stay was 1.1 days. Symptoms were ameliorated in 95%, with significant or complete symptom control in 80% of the patients for a mean of 10+ months (range 6–24 months). All patients were followed for a mean ± SEM of 1.6 ± 0.2 years (range 1.0–5.4 years). During this period new liver lesions developed in 28% of patients, new extrahepatic disease in 25%, and local liver recurrence in 13%; existing liver lesions progressed in 13%. Overall 41% of patients showed no progression of their cancer. Nine patients (27%) died. Mean ± SEM survivals after diagnosis of primary disease, detection of liver metastases, and performance of RFA were 5.5 ± 0.8 years, 3.0 ± 0.3 years, and 1.6 ± 0.2 years, respectively. Sixty-five percent of the patients demonstrated a partial or significant decrease in their tumor markers during follow-up. In conclusion, RFA provides excellent local tumor control with overnight hospitalization and low morbidity in the treatment of liver metastases from neuroendocrine tumors. It is a useful modality in the management of these challenging group of patients.     

Laparoscopic radiofrequency ablation of liver tumors combined with colorectal procedures

Laparoscopic radiofrequency ablation (RFA) is gaining increasing acceptance as a treatment option for primary and secondary liver tumors with minimal morbidity. The purpose of this study is to see if adding a colorectal procedure to RFA increases the risk of hepatic abscess. Of the 310 patients with 1,080 primary and secondary liver tumors undergoing laparoscopic radiofrequency ablation (RFA), 16 patients underwent RFA in combination with various colorectal procedures. Data were collected prospectively. The concomitant procedures included loop ileostomy closures in 6 patients; laparoscopic-assisted right hemicolectomy in 3 patients; laparoscopic-assisted anterior resection in 2 patients; and open transverse colectomy, open anterior resection, open low anterior resection, open loop transverse colostomy formation, and anal stricture dilatation in 1 patient each. Mean +/- SD hospital stay was 2.9 +/- 1.7 days. There was no mortality, and the only complication was the development of a right flank abscess after laparoscopic-assisted right hemicolectomy that was treated with percutaneous drainage. Although patients undergoing laparoscopic RFA in combination with a clean-contaminated procedure could be at high risk for secondary infection of ablated foci, this was not observed. This approach is safe and does not impair recovery from either procedure. These data support the concept that RFA may be safely used with concomitant colon resections to treat liver metastases that may be resectable but are associated with increased morbidity if resected synchronously.     

肝细胞癌合并肝硬化病人的腹腔镜射频消融治疗

目的探讨肝细胞癌合并肝硬化病人行腹腔镜射频消融(LRFA)治疗的可行性、安全性及疗效。方法2001年8月至2003年12月,25例肝细胞癌合并肝硬化病人在全麻下进行了LRFA治疗。男19例,女6例,平均年龄(52·2±11·9)岁。术前经超声、螺旋CT或MRI等检查共发现瘤体38个,平均肿瘤直径(3·8±1·1)cm。肿瘤均位于肝脏表面、肝左外叶或邻近胆囊等空腔脏器。肝功能均为ChildA或B级。合并慢性结石性胆囊炎3例,糖尿病2例,凝血功能障碍5例。术中行腹腔镜超声检查及病理活检。结果25例病人腹腔镜及术中超声检查共发现瘤体41个。所有病例均顺利完成LRFA治疗,同时行胆囊切除术5例。平均手术时间(72·5±27·6)min。未出现出血、胆道、胃肠道及膈肌损伤等并发症。术后1个月螺旋CT扫描证实,肿瘤完全坏死率达100%。随访6~32个月(平均18个月),1例发现肝内新病灶,3例射频治疗部位复发,l例死于肿瘤复发及肝功能衰竭。结论肝细胞癌合并肝硬化病人行LRFA治疗是安全可行的,可提高肝细胞癌射频消融治疗效果,减少并发症。     

超声引导下经皮射频消融治疗肝癌

目的观察超声引导下射频消融术(RFA)治疗肝癌(LC)的效果。方法回顾性分析165例LC,其中52例接受保守治疗(保守治疗组),55例(60个肿瘤)接受手术治疗(手术治疗组),58例(64个肿瘤)接受超声引导下射频消融治疗(RFA组),于治疗前后接受CEUS、CT或PET-CT、肝功能、甲胎蛋白(AFP)、癌胚抗原(CEA)等检查,并定期接受临床随访。结果 RFA组患者住院时间和费用明显低于保守治疗组和手术治疗组(P均<0.05);治疗后3个月有效率在手术治疗组与RFA组间差异无统计学意义(P>0.05),但明显高于保守治疗组(P<0.05);3组患者的肝功能指标、AFP、CEA均较治疗前明显下降(P均<0.05),手术治疗组与RFA组优于保守治疗组(P均<0.05);2年生存率在手术治疗组与RFA组间差异无统计学意义(P>0.05),但均明显高于保守治疗组(P均<0.05)。结论超声引导下射频消融治疗原发及转移性LC有效、安全、费用低,特别适用于不能耐受或者不愿手术且直径<5cm的肿瘤。     

肝脏海绵状血管瘤合并肝硬化的腹腔镜射频消融治疗

目的探讨肝脏海绵状血管瘤(hepatic cavernous hem angiom a,HCH)合并肝硬化病人行腹腔镜射频消融(rad iofrequency ab lation,RFA)治疗的可行性、安全性及疗效。方法2001年3月~2005年8月,15例HCH合并肝硬化病人在全麻下进行腹腔镜RFA治疗。男6例,女9例,年龄(46.2±7.0)岁。均有上腹部不适、疼痛或腹胀。乙型肝炎13例,丙型肝炎2例。肝功能Ch ild A级10例,Ch ild B级5例。术前经超声、螺旋CT或MR I等检查共发现病灶20个,肿瘤直径(7.2±1.4)cm。病灶均位于肝脏表面或临近胆囊等空腔脏器。血小板计数(31.2±10.4)×109/L。合并慢性结石性胆囊炎3例,糖尿病2例。术中行腹腔镜超声检查及病理活检。结果15例均顺利完成腹腔镜RFA治疗,同时行胆囊切除术3例。单个病灶射频治疗时间(68.8±34.0)m in,总手术时间(120.0±28.0)m in。未出现腹腔出血、胃肠道损伤、膈肌损伤、胆漏及肝功能衰竭等严重并发症。术后1个月螺旋CT增强扫描证实,肿瘤完全坏死率达100%(20/20)。随访5~31个月,中位15个月,13例症状完全消失,2例症状明显改善。结论HCH合并肝硬化病人行腹腔镜RFA治疗安全可行,治疗效果肯定,并有效避免了并发症的发生。     

腹腔镜结直肠癌切除术联合射频消融治疗肝转移癌

目的 探讨腹腔镜结直肠癌切除术+同期RFA治疗肝转移癌的临床价值.方法 2001年12月至2006年7月成都市第三人民医院对22例结直肠癌合并同时性肝转移的患者施行腹腔镜结直肠癌切除术+同期RFA治疗肝转移癌,术后通过增强CT检查评价消融灶固化效果.采用X2检验分析疗效.结果 本组22例患者中8例肝转移癌为多发,16例有合并症.对31个肝转移癌进行RFA治疗,未发生相关并发症;术后平均住院时间为(14±5)d,无手术死亡.5例因消融不完全进行重复RFA,4例消融灶复发(2例重复RFA);6例死亡(2例死于消融灶复发).消融灶复发率为18%(4/22),病死率为27%(6/22).肝转移癌直径≥2.0 cm者RFA后消融灶复发率高于直径＜2.0 cm者(x2=5.867,P＜0.05).结论 腹腔镜结直肠癌切除术+同期RFA治疗肝转移癌,为多发性肝转移癌、合并基础疾病、高龄、手术耐受差和肿瘤切除困难的结直肠癌患者提供了治疗的机会.     

Laparoscopic radiofrequency ablation of unresectable liver malignancies: feasibility and clinical outcome

Radiofrequency ablation (RFA) is a safe and effective treatment in patients with unresectable liver malignancies. Since there is little information on its optimal approach, the feasibility, clinical outcome, and efficacy of laparoscopic RFA need further investigation. Twenty-three consecutive patients with unresectable hepatic malignancies were treated with RFA. RFA was performed percutaneously in 5 patients (5 tumors; median maximum diameter of 25 mm [range, 20-73]), via laparotomy in 9 (28 tumors; median maximum diameter of 38 mm [5-90]), and via laparoscopy in 9 (16 tumors; median maximum diameter of 35 mm [8-58]). Mortality and intraoperative complication rates were 0. In the laparoscopy and laparotomy groups, mean blood loss was 13 mL versus 421 mL and mean hospital stay was 5.7 versus 11.2 days, respectively (P = 0.0008 and P = 0.04). Postoperative complications occurred in one patient after laparoscopic RFA and in three after RFA via laparotomy. After a median follow-up of 12.2 months, local recurrence occurred in 2 patients (laparoscopic RFA, 1; percutaneous RFA, 1), and new hepatic tumors developed in 7 (laparoscopic RFA, 2/9; RFA via laparotomy, 5/9). Laparoscopic RFA is a safe and feasible treatment modality to achieve tumor destruction in selected patients with unresectable hepatic malignancies.     

第一肝门区小肝癌的经皮肝穿刺射频消融治疗

目的探讨对于位于第一肝门区的小肝癌行B超引导经皮肝穿刺射频消融(PRFA)治疗的可行性、疗效和应注意的问题。方法2000年4月至2002年10月选择肿瘤位于第一肝门区、≤5cm、病理或临床证实为原发性或继发性肝癌的21例患者进行PRFA治疗。治疗前甲胎蛋白(AFP)阳性者治疗后定期复查AFP。治疗后1个月复查MRI或CT确定肿瘤是否完全坏死,以后每3个月定期复查。Kaplan-Meier法计算“无瘤”生存率和累积生存率。结果AFP转阴率约为78％,MRI或CT显示第一肝门区肿瘤完全凝固坏死率为90．5％(19／21)。0．5、1、1．5、2年无原位复发生存率均为94．7％;0．5、1、1.5、2年无“瘤旁复发”生存率分别为90．0％、77．1％、77．1％和77．1％;0．5、1、1．5、2年总生存率分别为89．2％、82．8％、82．8％和55．2％。胆管狭窄发生率为4．8％。结论第一肝门区小肝癌并非PRFA治疗的禁忌证,只要治疗时穿刺点选择恰当、穿刺路径合理、超声监测下电极展开确切、热凝范围控制恰当,对于第一肝门区小肝癌PRFA是一种行之有效的治疗方法。     

Laparoscopic liver resection assisted with radiofrequency

BACKGROUND: Radiofrequency-assisted laparoscopic liver resection is reported. METHODS: Patients suitable for liver resection were carefully assessed for laparoscopic resection. Patient and intraoperative and postoperative data were prospectively collected and analyzed. RESULTS: Eighteen patients underwent laparoscopic liver resection. All operations were performed without vascular clamping and consisting of tumorectomy (n = 9), multiple tumoretcomies (n = 2), segmentectomy (n = 2), and bisegmentectomies (n = 2). Mean blood loss was 121 +/- 68 mL, and mean resection was time 167 +/- 45 minutes. There was no need for perioperative or postoperative transfusion of blood or blood products. One patient developed pneumothorax during surgery as a result of direct puncture of pleura with the radiofrequency probe, and 1 patient had transient liver failure and required supportive care after surgery. The mean length of hospital stay was 6.0 +/-1.5 days. At follow-up, those with liver cancer had no recurrence. CONCLUSIONS: Radiofrequency-assist laparoscopic liver resection can decrease the risk of intraoperative bleeding and blood transfusion.     

腔镜保乳手术联合射频消融术治疗早期乳腺癌的临床研究

目的 探索腔镜保乳手术联合射频消融术治疗早期乳腺癌的可行性及疗效分析.方法 回顾性分析2014年1月-2016年12月首都医科大学附属北京友谊医院普通外科行腔镜保乳手术的55例早期乳腺癌女性患者的病例资料,其中27例行腔镜保乳手术联合射频消融术,28例行单纯腔镜保乳手术而未行射频消融术,并通过t检验及x2检验的统计学方法来明确两组之间的差异是否存在统计学意义.本临床研究主要评价指标为术后局部复发情况、脂肪液化的发病率、手术时间、术后住院时间、住院费用.结果 腔镜保乳手术联合射频消融术组局部复发率低于未行射频消融术组(分别为0和7.69％).同时,在脂肪液化这一可能影响术后康复的并发症方面,两组之间差异无统计学意义(P =0.236).但是,腔镜保乳手术联合射频消融术组较未行射频消融术组住院费用高[分别为(4.1±0.7)万元和(2.3±0.6)万元,P＜0.05].结论 采用腔镜保乳手术联合射频消融术治疗早期乳腺癌,虽然因使用射频消融术相关设备和器械会导致住院费用增加,但此手术方式不仅具备清除乳腺残腔中微小癌残留的优点,而且在减少术后肿瘤复发率的同时不增加术后脂肪液化的发病率.因此,此手术方式将会成为乳腺癌微创手术治疗的重要发展方向之一.     

Laparoscopic partial splenectomy using radiofrequency ablation

INTRODUCTION: Epidermoid cysts are believed to be congenital in origin and often present in the pediatric population. Because of the concerns of compromised immunologic function after total splenectomy and increasing demand for minimally invasive approaches, interest has increased in performing the partial splenectomy in this patient population by laparoscopic techniques. Nonetheless, concerns for adequate hemostasis have limited its widespread adoption. Because radiofrequency ablation for the partial splenectomy has been done in a laparoscopic porcine model with good results, we used this technology with the goal of limiting blood loss and postoperative hemorrhagic complications. CASE REPORT: A 25-year-old female presented with complaints of right shoulder pain. Abdominal ultrasound and a computed tomography (CT) scan revealed a 10-cm cystic lesion of the spleen. Serology was negative for hydatid cyst pathology. The patient underwent an uneventful partial splenectomy by minimally invasive techniques with the aid of a laparoscopic radiofrequency ablative device and the placement of a hemostatic medicated sponge along the line of transection. RESULTS: Estimated blood loss was less than 30 mL. Final pathology was consistent with an epidermoid splenic cyst, and the patient was discharged uneventfully on postoperative day 5. DISCUSSION: Techniques for the treatment of symptomatic splenic cysts range from total splenectomy to cyst fenestration and placement of the omentum in the splenic defect. The use of radiofrequency ablation has been traditionally used for hepatic parenchymal transection but seems equally suited for the partial splenectomy. This technology, and the addition of hemostatic sponges, seems to provide excellent results in minimizing blood loss, intraoperatively and postoperatively, during the laparoscopic partial splenectomy; however, randomized, prospective trials will be necessary to see if they will be superior to traditional techniques.     

射频凝固器在肝癌肝切除术中的应用

目的 探讨射频凝固器与传统钳夹法行肝癌肝切除术对术中出血和术后并发症的影响.方法 回顾性分析2011年1月至2012年6月第三军医大学西南医院收治的130例肝癌患者的临床资料,采用配对病例对照研究方法,将65例采用射频凝固器进行肝切除术的肝癌患者设立为射频凝固器组;同时根据肿瘤的大小、部位和Child-Pugh分级在肝癌数据库中配对选取65例临床病理特征类似的采用传统钳夹法进行肝切除术的患者设立为传统钳夹组.对两组患者术中和术后的相关参数进行统计学对比分析.计量资料用中位数加范围表示,均数比较用方差分析;计数资料比较用x2检验,当例数＜ 10时采用Fisher确切概率法.结果 射频凝固器组患者的术中断肝时间和肝门阻断时间分别为28 min(12～55 min)和10 min(0～ 15 min),明显短于传统钳夹组的45min(25 ～92m in)和15 min(10～32min),两组比较,差异有统计学意义(F=10.35,9.05,P＜0.05);射频凝固器组患者的术中出血量和术中输血量分别为150ml(50 ～350ml)和0ml,显著少于传统钳夹组的450 ml (250～ 2500 ml)和550 ml(0～2000 ml),两组比较,差异有统计学意义(F=15.86,P＜0.05);射频凝固器组65例患者未输血,显著多于传统钳夹组的48例(x2=19.58,P＜0.05).射频凝固器组患者术后第3、7天AST和TBil,术后第3天PT、Clavien外科并发症分级、住院时间分别为302 U/L(89 ～823 U/L)、54 U/L(16 ～325 U/L)、37 μmol/L(18～112 μmol/L)、24 μmol/L(9～66 μmol/L)、15 s(11 ～20 s)、22％(14/65)、12 d(8 ～36 d),与传统钳夹组的253 U/L(63～876 U/L)、62 U/L(22 ～ 376 U/L)、41 μmol/L(19 ～ 105 μmol/L)、25tμmol/L(11 ～59 μmol/L)、14 s(11 ～21 s)、26％ (17/65)、13 d(9 ～35 d)比较,差异无统计学意义(F =2.59,1.93,3.96,1.58,2.35,x2=0.381,F=1.58,P＞0.05);射频凝固器并发症发生率为17％(11/65),显著低于传统钳夹组的52％(34/65),两组比较,差异有统计学意义(x2=17.38,P＜0.05).其中射频凝固组只有2例患者发生术后出血,显著少于传统钳夹组的22例.但射频凝固器组有8例患者发生断面包裹性积液,其中5例需穿刺引流.传统钳夹组有2例患者发生肝功能不全;射频凝固器组有2例患者发生血红蛋白尿.结论 与传统钳夹法比较,射频凝固器行肝切除术具有出血少、安全、快捷的优点.     

射频消融在胃癌肝转移中的临床应用

胃癌肝转移是胃癌的晚期阶段,也是导致胃癌患者死亡的主要原因。射频消融因其安全性高、创伤小、可多次治疗等成为胃癌肝转移综合性治疗方案中可供选择的手段之一。本文对胃癌肝转移射频消融治疗疗效、射频消融联合其他治疗的疗效、影响射频消融预后的因素等进行综述。     

腹腔镜射频消融术治疗肝血管瘤

目的 :探讨腹腔镜射频消融治疗肝血管瘤的可行性及实用性。方法 :2 5例肝血管瘤患者全麻气管插管后 ,腹腔镜下行射频消融治疗 ,其中 5例同时行胆囊切除术。结果 :患者经治疗均获满意效果 ,术后无残留病灶 ,无明显并发症。结论 :腹腔镜射频消融治疗肝血管瘤安全可行 ,治疗彻底 ,是治疗肝血管瘤的微创新技术。     

难治性肝癌射频消融治疗策略

射频消融(RFA)治疗肝肿瘤的安全性及有效性已得到广泛认可。但对于难治性肝癌,RFA治疗难度及风险大幅提高。重视影像指导下的规范化治疗及个体化治疗及策略,对难治性肝癌将同样可获得较好的疗效及安全性。     

芬太尼和舒芬太尼对肝癌患者射频消融术后肝功能的影响

目的 探讨等效剂量的芬太尼和舒芬太尼对肝癌患者射频消融术后肝功能的影响。
方法 回顾性分析2016年1月1日至2019年12月31日行射频消融的肝癌患者（单发肿瘤≤3 cm）211例,男166例,女45例,Child-Pugh A级。根据术中使用药物分为两组：芬太尼组（n=92）和舒芬太尼组（n=119）。记录性别、年龄、BMI、肿瘤大小、手术时间、吸烟饮酒史、基础疾病（高血压、糖尿病）等临床资料和ALT、AST、TBiL、ALP、LDH、ALB、GGT等肝功能指标,以及保肝药物（甘草酸二铵）的使用情况。采用分层Logistic回归筛选肝癌射频消融患者术后1 d ALT＞3×ULN的独立影响因素。
结果 与术前1 d比较,两组术后1 d的ALT、AST、TBiL和LDH明显升高,术后7 d的ALT和AST明显升高（P<0.05）。与术后1 d比较,两组术后7 d的ALT、AST、TBiL和LDH均明显降低（P<0.05）。与芬太尼组比较,舒芬太尼组术后1 d的ALT和AST明显降低（P<0.05）。分层Logistic回归结果显示,使用舒芬太尼且年龄<65岁（OR=0.301,95%CI 0.149～0.610,P=0.001）、肿瘤大小1.1～2.0 cm（OR=0.417,95%CI 0.191～0.910,P=0.028）、手术时间10～20 min（OR=0.231,95%CI 0.081～0.658,P=0.006）是术后1 d ALT>3×ULN的保护因素。
结论 对于早期肝癌行射频消融治疗的患者,术中使用舒芬太尼患者的肝功能指标明显优于使用芬太尼患者,术中使用舒芬太尼是术后1 d ALT＞3×ULN的保护因素。     

Laparoscopic radiofrequency ablation of hepatic cavernous hemangioma

BACKGROUND: Radiofrequency ablation (RFA), currently used extensively for liver tumors, also has been applied successfully to hepatic cavernous hemangioma (HCH) percutaneously. The aim of this study was to assess the feasibility, safety, and efficacy of laparoscopic RFA for patients with HCHs. METHODS: Between March 2001 and March 2004, 27 patients with symptomatic and rapid-growth lesions were treated by laparoscopic RFA using the RF-2000 generator system. The treatment-related complications were observed. All the patients were followed up with helical computed tomography scans and ultrasonography at regular intervals to assess the therapeutic efficacy of laparoscopic RFA. RESULTS: This study assessed 9 men and 18 women with a mean age of 41.6 +/- 8.3 years. Three additional intrahepatic lesions missed preoperatively were found in three patients on intraoperative ultrasound. A total of 27 patients with 50 liver lesions were treated successfully with laparoscopic RFA. The mean maximum tumor diameter was 5.5 +/- 2.0 cm. The mean length of time for RFA per lesion was 20.7 +/- 11.9 min, and the mean blood loss was 134.4 +/- 88.9 ml. Laparoscopic cholecystectomy was performed simultaneously for gallstones in 13 patients and for abutting of gallbladder from hemangioma in 2 patients. In addition, 3 patients also had a laparoscopic deroofing of simple hepatic cysts. Although postoperative low-grade fever and transient elevation of serum transaminase levels were observed in 13 patients, there were no complications related to laparoscopic RFA. During a median follow-up period of 21 months (range, 12-42 months), complete lesion necrosis was achieved for all the patients. CONCLUSIONS: Laparoscopic RFA therapy is a safe, feasible, and effective treatment option for patients with symptomatic and rapid-growth HCHs located on the surface of the liver or adjacent to the gallbladder. Intraoperative ultrasonography is a useful adjunct for detecting additional liver lesions and offering more accurate targeting for RFA.     

Laparoscopic radiofrequency ablation of primary and metastaticliver tumors

BACKGROUND: Radiofrequency thermal ablation is a new technology for the local destruction of liver tumors. Since we first described laparoscopic radiofrequency ablation (LRFA) for the treatment of liver tumors, much has been learned about patient selection, laparoscopic ultrasound (LU) guided placement of the ablation catheter, monitoring of the ablation process, and patient follow-up. METHODS: Since January 1996 we have performed LRFA of 250 tumors in 67 patients including 85 adenocarcinomas, 107 neuroendocrine tumors, 34 sarcomas, 1 melanoma, and 11 hepatomas. We used LU to guide placement of the ablation catheter and to monitor the ablation process. Most of the patients had two trocars (camera and laparoscopic ultrasound) with the 15-gauge ablation catheter (RITA Medical Systems, Mountain View, CA, USA) placed percutaneously. RESULTS: The LRFA procedure was completed successfully in all patients, with 1 to 14 lesions per patient, ranging in size from 0.5 to 10 cm in diameter. The entire liver could be examined by LU via right subcostal ports. Criteria for successful ablation were 5-min ablation times at 100 degrees C with 1-min cool-down temperatures of 60 degrees to 70 degrees C. Outgassing of dissolved nitrogen, monitored by ultrasound, was useful in confirming the zone of ablation. Intralesional color-flow Doppler, seen before ablation, was eliminated after ablation. Placement of the grounding pad closer to the lesion on the back rather than the thigh resulted in more efficient energy delivery to the tumor. Lesions larger than 3 cm in diameter required overlapping ablations to achieve a 1-cm margin of normal liver. Most patients required overnight hospitalization, with no coagulopathy or electrolyte disturbances noted. CONCLUSIONS: The LRFA procedure is a novel, minimally invasive technique for treatment of liver tumors that have failed conventional therapy. This study documents the technical aspects of targeting lesions and performing reproducible zones of ablation. Familiarity with these techniques should lead to more widespread application.