Evaluation of a bipolar radiofrequency device for laparoscopic hepatic resection: technique and clinical experience in 18 patients

Background:

The increased frequency of laparoscopic hepatic resection as a principal or adjunct component of patient care has driven the need for and development of efficient and safe hepatic parenchymal transection technologies. At present, various devices are available for pre-coagulation transection (PCT) of hepatic parenchyma with the intent of minimizing procedure-associated postoperative haemorrhage and bile leak. This report presents the evaluation of a novel bipolar radiofrequency (RF) energy device for PCT used for laparoscopic hepatic resection.

Methods:

Patients undergoing laparoscopic hepatic resection using the Enseal™ device (SurgRx Inc.) were identified from the prospectively maintained hepatobiliary database. Information on patient demographics, procedures and postoperative complications was collected and analysed; complications were grouped into early (at <30 days) and late (at ≥30 days) events.

Results:

A total of 18 patients, of whom 13 had malignant tumours (12 colorectal metastases and one hepatocellular carcinoma) and five had benign tumours (two hepatic adenomas and three haemangiomas) underwent 18 hepatic procedures, including two formal hemi-hepatectomies, four left lateral sections, three posterior sections and nine atypical non-anatomic resections. Estimated blood loss did not differ from institutional historical control data; no postoperative haemorrhage, bile leaks or hepatic abscess or necrosis were identified (n = 18).

Conclusions:

This initial experience using the laparoscopic bipolar RF device demonstrates an acceptable safety profile in terms of the outcomes analysed.     

Percutaneous and laparoscopic approaches of radiofrequency ablation treatment for liver cancer

Background/Purpose. Radiofrequency ablation (RFA) and microwave coagulation therapy (MCT) have been gaining acceptance as a standard method in the management strategy of liver cancer, for reasons of minimally invasive techniques and effective results. We present our experience of RFA and MCT in patients with liver cancer, and analyze retrospectively the advantages and disadvantages of both of the percutaneous and laparoscopic approaches. Methods. Thirty-two consecutive patients (23 men and 9 women) with 19 hepatocellular carcinomas (HCC), 12 metastatic liver cancers, and recurrent cholangiocellular carcinoma (CCC), were enrolled in this study. Out of these 32 patients, as a prior laparotomy, 19 underwent hepatectomy, colectomy, gastrectomy or cholecystectomy, and 15 were treated with the laparoscopic approach, 17 treated with the percutaneous approach, and 2 treated with the combined approach of those two. All of these procedures were carried out under general anesthesia with ultrasound guidance. Seven and 30 days after these procedures, an assessment helical computed tomography was done. Results. No sign of the residual tissues was noted in all patients except only one case. Conclusions. The percutaneous approach was thought to be a more practical and less invasive method regardless previous laparotomy. For the laparoscopic approach, tumors located at the hepatic surface or margin were preferable candidates.     

Combined hepatic resection and radiofrequency ablation for multiple hepatic adenomas

We describe the novel use of radiofrequency ablation (RFA) in combination with surgical resection for treatment of multifocal hepatic adenoma. We show three cases without recurrent lesions detected in follow-up examination. Two of the patients have subsequently gone on to carry pregnancies successfully to term.     

Pilot study for a new bipolar radiofrequency ablation/aspirator device in the management of primary and secondary liver cancers

Background: In the US, the thermal ablation workload for cancer involving the liver is predicted to more than double in the next 5 years, emphasising the need to develop and improve the current technology. Study Design: A multicentre nonrandomised prospective clinical trial (NCT00514930) was undertaken, to assess the efficacy and safety of a new bipolar radiofrequency ablation/aspirator device, in the treatment of primary and secondary cancers of the liver. Results: A total of 34 lesions in 16 patients were ablated at laparotomy and followed up at 4 weeks. The mean diameter of lesion before ablation was 3.2±2.22 (range 1–10) cm, the mean volume aspirated during ablation was 9.25±7.3 (range 0–25) ml and the mean operative time was 145.95±40.7 (range 60–215) min. There was one major complication of a pleural effusion, which required drainage. The mean length of stay was 8±3.2 (range 3–14) days. In 11 patients, the ablated tumour was resected. On histological assessment, there was no evidence of viable cancer at the tumour edge. On follow‐up computed tomography, the ablation zone fully encompassed the targeted tumour and there were no local complications related to ablation. Conclusion: Initial analysis of the data from this small cohort, with only a short‐term follow‐up, shows this device to be safe and effective.     

Forging ahead: Update on radiofrequency ablation technology and techniques

Innovations in radiofrequency (RF) ablation and nonablative techniques have led to significant advances in addressing complex arrhythmogenic substrates for a variety of cardiac arrhythmias. Anatomical challenges, deep substrate, and mid‐myocardial locations may pose difficulties and decrease success rates using routine methods. In this review, we provide an update on novel RF technology and techniques including (a) high‐power, low‐duration ablation, (b) ablation facilitated by low‐ionic irrigant, and (c) bipolar ablation. In addition, we review emerging technologies including electroporation, needle catheter ablation, and ablation with the lattice catheter.     

Treatment of hepatic cysts by B-ultrasound-guided radiofrequency ablation

BACKGROUND:The traditional therapy for hepatic cysts has limited success because of recrudescence. Radiofrequency ablation(RFA)has become popular because of its advantages including little damage,therapeutic effect and reduced suffering.This report describes the effects and reliability of RFA in the treatment of 29 patients with hepatic cysts. METHODS:B-ultrasound-guided RFA was used to treat hepatic mono-cyst or multi-cysts of 29 patients(63 tumors). Ablative efficiency and complications were assessed by imaging and clinical symptoms. RESULTS:The tumors were abated completely in 34 cysts with a diameter<5 cm and no recurrence was seen after 3 months.In 21 cysts with a diameter of 5-10 cm,tumor volume was decreased by over 70%,then reduction and fiberosis were found.In 8 cysts with a diameter greater than 10 cm,tumor volume was decreased by more than 60%,and in 2 cysts it was increased more slightly than that at 1 month after RFA.In subsequent follow-up(6 and 12 months after RFA),tumors<10 cm in diameter were fully ablated.No significant discomfort and complications were found in any patient. CONCLUSION:RFA for the treatment of hepatic cysts is safe,and free from complications.     

A prospective study of in-line radiofrequency ablation in hepatic parenchymal transection--its efficacy and complications

Background. Bleeding during liver transection remains a potential hazard. This study aims to report the efficacy and complications of in-line radiofrequency ablation (ILRFA)-assisted liver resection. Patients and methods. The blood loss of 25 consecutive patients who underwent ILRFA-assisted liver resection was obtained by weighing swabs and measuring suction jar contents during liver resection and calculated in ml per cm² of the transection surface area. Postoperative complications were recorded. Five clinical variables, which might affect blood loss, were analyzed. Results. The mean blood loss during parenchymal dissection for the ILRFA group was 3.4±3.2 ml/cm². Three patients had intra-abdominal collections, including one patient with bile leakage after ILRFA-assisted liver resection. Age, gender, extent of liver resection, liver quality and Pringle maneuver did not demonstrate significant impact on blood loss. Conclusions. This study showed that ILRFA-assisted liver resection was associated with very low blood loss. This is likely to improve the operative safety of liver resection for hepatic tumors. There were no significant postoperative sequelae.     

国产可调节输出功率的双极射频消融装置的离体动物实验

目的 研究不同输出功率下,双极射频消融装置对不同厚度离体心房组织消融至透壁所需的时间及使用阻抗指标评价透壁性时的病理学检验,从而确定国产消融装置的合理输出功率.方法 20头猪屠宰后马上获取猪心,立即浸入4℃的生理盐水溶液中,清洗后制备离体心房组织.使用自行研制的输出功率可调式双极射频消融装置及消融钳,分别使用25 W、30 W及35 W的输出功率对离体心房组织进行消融.消融线间隔约5mm,彼此间平行.消融透壁的指标是消融时该处同时测定的电阻抗大于100 Ω.依次使用相同的输出功率,记录对不同厚度心房组织完成消融所需时间.消融完成后,沿两条消融线中点依次剪开心房组织,肉眼检查消融效果,测量消融线处组织厚度.按消融组织厚度,将心房组织分成＜2 mm、2～4 mm（≥2 mm,＜4 mm）、4～6 mm（≥4 mm,＜6 mm）及≥6mm4组.对应于不同输出功率和厚度,将心房组织分为12个区组.分别随机挑选每个区组的心房组织10块,将心房组织浸入多聚甲醛溶液,固定后心房组织使用石蜡切片,Mason三色法染色,显微镜下检验是否透壁.结果 实验共有350条消融线到达透壁指标.4～6 mm及＞6 mm组的心房组织消融完成时间明显长于＜2 mm组心房组织[（12.4±0.9）s比（24.3±0.3）s,P=0.042;（12.4±0.9）s比（35.9±0.3）s,P=0.001].消融完成时间在输出功率25 W与35 W间有显著差异[（28.9±0.5）s比（16.9±0.5）s,P=0.010].心房组织厚度与消融完成时间呈正相关.单次消融到达消融透壁指标时的病理透壁率为0～60％,随心房厚度增厚而降低,随输出功率增加而升高.结论 心房组织的消融完成时间随射频输出功率增加而缩短,并与心房组织厚度呈正相关.单次射频消融的透壁率较低.综合考虑消融所需时间、透壁率及安全性,输出功率在30～35 W是国产消融仪较为合理的射频输出功率.     

射频消融治疗肝血管瘤的现状

简述了目前射频消融术治疗肝血管瘤的进展,主要对射频电极、治疗方式、并发症及防治进行介绍,为规范肝血管瘤射频消融治疗奠定基础。射频消融术作为肝血管瘤重要的微创技术,其规范化有助于临床应用推广及发展。     

左心房内径大于60 mm心房颤动患者行改良迷宫射频消融术的疗效

目的 评价改良迷宫双极射频消融术在左心房内径＞60 mm患者中治疗心房颤动（房颤）的临床疗效.方法 对同一术者在瓣膜置换同期行改良迷宫双极射频消融术并随访9个月以上的患者106例,按左心房内径大小分为两组：观察组左心房内径＞60 mm（27例）,对照组左心房内径＜60 mm（79例）.对所有患者进行随访分析,比较两组手术疗效.结果 两组手术并发症发生率比较,差异无统计学意义（P＞0.05）.观察组术后当日恢复窦性心律23例,心房扑动1例,房颤2例,交界性心律1例,房颤消除率为88.9％.出院时窦性心律22例,心房扑动2例,房颤消除率为88.9％.术后9～12个月窦性心律21例,房颤6例,房颤消除率为77.8％.对照组术后当日恢复窦性心律71例,心房扑动1例,房颤5例,交界性心律2例,房颤消除率为91.1％.术后9～12个月窦性心律70例,房颤9例,房颤消除率为88.6％.随访至术后9～12个月观察组房颤消除率与对照组相比,差异无统计学意义[77.8％（21/27）vs.88.6％（70/79）,P＞0.05].结论 左心房内径＞60 mm的患者行改良迷宫双极射频消融术治疗房颤安全、简便,仍可获得较好的近期疗效.对左心房显著增大的患者,增加左心房后壁消融线路,术后注意避免过高的中心静脉压、维持钾离子浓度在正常高值,有利于提高手术疗效.     

手术切除与射频消融治疗小肝癌的疗效比较

目的比较小肝癌手术切除与射频消融（RFA）初治后疗效及复发情况。方法收集吉林大学白求恩第一医院2002年1月至2008年12月接受手术或RFA初治的97例小肝癌患者资料,并对治疗后满2年的患者进行随访,共随访到63例,手术和RFA治疗分别为34和29例,回顾性分析两种方法治疗小肝癌患者的预后复发情况。计量资料采用χ2检验,利用Cox回归分析比较影响患者复发相关的危险因素,并应用Log-rank进行两种无瘤生存率检验。结果手术与射频消融治疗小肝癌3个月、1、2 a复发率分别15%、38%、64%,21%、35%、45%,两者差异无统计学意义。初治后复发与治疗方法、性别、年龄、Child-Pugh分级、肿瘤大小、结节数目、是否合并有肝硬化、甲胎蛋白水平相关性差异无统计学意义,两者无瘤生存率差异无统计学意义。结论 RFA与肝癌切除术在治疗小肝癌取得相近的治疗效果,RFA有望成为替代手术治疗的一种理想的治疗方法。     

Cost of radiofrequency ablation in the treatment of hepatic malignancies

OBJECTIVES: Our primary objective was to assess the cost of radio-frequency ablation (RFA) of hepatic malignancies and to compare it to hospital reimbursement paid in the French Prospective Payment System (PPS). PATIENTS AND METHODS: A series of 305 patients were enrolled into a prospective study. All resources used during the RFA-related hospital stay were recorded. Costs were assessed from the perspective of the health care providers and computed for four groups of patients: percutaneous RFA in an outpatient setting (group Ia, N=44), percutaneous RFA in an inpatient setting (group Ib, N=94), laparoscopic RFA (group II, N=44) and intraoperative RFA combined with resection (group III, N=120). RESULTS: Mean hospital costs were estimated at euro 1581 (group Ia), euro 3824 (group Ib), euro 8194 (group II) and euro 12967 (group III). Costs per stay without intensive care in these groups were respectively euro 1581, euro 3635, euro 6622 and euro 10905 and reimbursement (intensive care excluded) was euro 560, euro 3367, euro 9084 and euro 11780. CONCLUSION: In the French PPS, the cost of RFA is covered by lump sums paid to hospitals exclusively for intraoperative and laparoscopic RFA. For percutaneous RFA, which is the most frequent approach, reimbursement is highly insufficient.     

双极射频消融心房颤动同时手术治疗器质性心脏病的临床效果

目的：探讨双极射频消融钳治疗心房颤动同期行开胸手术治疗器质性心脏病的手术方法和临床结果,提高对此类疾病的治疗水平。方法：回顾分析2009年8月～2012年5月对58例器质性心脏病并发心房颤动用双极射频消融钳治疗房颤的临床资料。结果：本组患者手术均顺利完成。射频时间16～38（24±4） min,主动脉阻断时间64～200（126±36） min,体外循环时间91～238（150±37） min;手术结束及出院时窦性心率分别为46（79%）,45（78%）例,随访3个月,6个月和12个月,窦性心率分别为41（71%）,40（69%）和42（72%）例。全组病例无手术死亡和射频相关并发症。所有患者均无需安装永久起搏器。双心房消融与单独左房消融比较无显著差异。结论：此方法可行,效果满意,但要注意把握适应证。     

Clinical efficacy analysis and safety evaluation of ultrasonographically guided percutaneous radiofrequency ablation in liver cancers

OBJECTIVE : To assess the clinical efficacy of radiofrequency (RF) ablation in treating liver cancers. The indications, contraindications and side-effects of the technique were also evaluated. METHODS : One hundred and fifty-four patients with liver cancers were treated between May 1999 and July 2000. One hundred and thirty-two cases were hepatocellular carcinomas (HCC) and 22 cases were metastatic liver cancers. The diameter of the cancers ranged from 1.5 to 19.0 cm, with a mean diameter of 7.07 cm. All patients were treated with RF2000TM RF under ultrasonographic guidance and the results and side effects were evaluated. RESULTS : One hundred and fifty-four patients were treated 182 times, with the average number of treatments for each patient being 1.18 and the average number of therapeutic points was 5.74. Symptoms improved after therapy and the levels of α-fetoprotein (AFP) dropped from 1553.68 to 883.70 ng/mL. The AFP level declined in 60.8% of patients, remained unchanged in 32.7% of patients and was elevated in 6.5% of patients. After RF ablation, the size of the tumor was reduced in 87 cases (56.6%), stabilized in 52 cases (33.7%) and enlarged in 15 cases (9.7%). The common side-effects of RF were local pain, fever and leukocytosis; no life-threatening complications were observed. CONCLUSIONS : Percutanous RF ablation of liver cancers is a simple, safe, effective method. It can be curative for small liver cancers but for large liver cancers multiple treatments combined with arterial chemoembolization therapy may be needed to enhance its effectiveness.