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Ypsilantis P, Lambropoulou M, Karayiannakis A, Zacharoulis D, Passos I, Smyrlis C, Charisis C, Ypsilantis K, Pitiakoudis M. Gut Barrier Disruption Secondary to Radiofrequency-Assisted Liver Parenchyma Resection in a Porcine Model. J Gastrointest Surg 2022; 26:1881-1889. [PMID: 35676456 DOI: 10.1007/s11605-022-05370-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/21/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Radiofrequency-assisted liver resection (RF-LR) techniques minimize intraoperative blood loss, while avoiding the Pringle maneuver. Both surgical excision and radiofrequency ablation of liver parenchyma compromise gut barrier function with subsequent bacterial translocation. The present study sought to investigate in a porcine model the impact of two RF-LR techniques on the integrity and inflammatory response of the gut barrier. METHODS Twenty-four pigs were subjected to either (a) partial hepatectomy (PH) employing the "sequential coagulate-cut" technique using a monopolar electrode (SCC group), the one using the bipolar Habib-4X device (group H), or the "crush-clamp" technique (group CC) or (b) sham operation (group Sham). At 48-h post-operation, ileal tissue was excised to be subjected to histopathologic examination, histomorphometric analysis, and immunohistochemical assessment of the mitotic and apoptotic activities and the expression of interleukin-6 (IL-6), tumor necrosis factor-α (TNFα), and nuclear factor-κB (NFκΒ). RESULTS Histopathologic score increased in all PH groups, being higher in group SCC, while lower in group H. Villous height decreased in group SCC only. Mitotic index decreased, while apoptotic index increased in all PH groups. An increase in tissue expression score was noted for IL-6 in group CC, for TNFα in all PH groups, being lower in group H compared to group CC, and for NFκB in all PH groups. CONCLUSIONS The Habib-4X technique for liver resection proved to preserve the integrity of gut barrier, being less injurious in the intestinal mucosa compared to the SCC and CC techniques.
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Affiliation(s)
- Petros Ypsilantis
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece.
| | - Maria Lambropoulou
- Laboratory of Histology and Embryology, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Anastasios Karayiannakis
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece
| | | | - Ioannis Passos
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece
| | - Christos Smyrlis
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece
| | - Christos Charisis
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece
| | - Konstantinos Ypsilantis
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece
| | - Michael Pitiakoudis
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece
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Muraki R, Morita Y, Ida S, Kitajima R, Furuhashi S, Takeda M, Kikuchi H, Hiramatsu Y, Fukazawa A, Sakaguchi T, Fukushima M, Okada E, Takeuchi H. Comparison of operative outcomes between monopolar and bipolar coagulation in hepatectomy: a propensity score-matched analysis in a single center. BMC Gastroenterol 2022; 22:154. [PMID: 35351001 PMCID: PMC8962169 DOI: 10.1186/s12876-022-02231-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/21/2022] [Indexed: 11/20/2022] Open
Abstract
Background Various hemostatic devices have been utilized to reduce blood loss during hepatectomy. Nonetheless, a comparison between monopolar and bipolar coagulation, particularly their usefulness or inferiority, has been poorly documented. The aim of this study is to reveal the characteristics of these hemostatic devices. Methods A total of 264 patients who underwent open hepatectomy at our institution from January 2009 to December 2018 were included. Monopolar and bipolar hemostatic devices were used in 160 (monopolar group) and 104 (bipolar group) cases, respectively. Operative outcomes and thermal damage to the resected specimens were compared between these groups using propensity score matching according to background factors. Multivariate logistic regression analysis was performed to identify predictive factors for postoperative complications. Results After propensity score matching, 73 patients per group were enrolled. The monopolar group had significantly lower total operative time (239 vs. 275 min; P = 0.013) and intraoperative blood loss (487 vs. 790 mL; P < 0.001). However, the incidence rates of ascites (27.4% vs. 8.2%; P = 0.002) and grade ≥ 3 intra-abdominal infection (12.3% vs. 2.7%; P = 0.028) were significantly higher in the monopolar group. Thermal damage to the resected specimens was significantly longer in the monopolar group (4.6 vs. 1.2 mm; P < 0.001). Use of monopolar hemostatic device was an independent risk factor for ascites (odds ratio, 5.626, 95% confidence interval 1.881–16.827; P = 0.002) and severe intra-abdominal infection (odds ratio, 5.905, 95% confidence interval 1.096–31.825; P = 0.039). Conclusions Although monopolar devices have an excellent hemostatic ability, they might damage the remnant liver. The use of monopolar devices can be one of the factors that increase the frequency of complications. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02231-y.
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Mulpuri VB, Gurijala DP, Yerolla BR, Kumar G, Dutt A. Liver Parenchymal Transection Through Radiofrequency Ablation Using a Radial Probe: Technical Report of a New Modality. Cureus 2021; 13:e20130. [PMID: 35003968 PMCID: PMC8726509 DOI: 10.7759/cureus.20130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2021] [Indexed: 11/05/2022] Open
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Zhou Y, Ouyang J, Wang Z, Chen X, Zhu R, Li Q, Zhou J. A novel internal cold circulation radiofrequency-assisted device for liver transection. Int J Hyperthermia 2021; 38:308-315. [PMID: 33627010 DOI: 10.1080/02656736.2021.1889046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of a new internal cold circulation bipolar radiofrequency compared with Habib-4X bipolar radiofrequency device in the resection of liver tumors. METHODS A total of 85 patients with hepatocellular carcinoma who received radiofrequency-assisted liver resection from February 2017 to January 2020 were retrospectively enrolled in our study, in which 45 patients received the new internal cold circulation bipolar radiofrequency (New-RF) and 40 patients received Habib-4X bipolar radiofrequency (Habib-4X). Primary outcome measures were the speed of liver transection, the width of coagulation tissue, hemorrhage volume, blood transfusion rate, and operation time. RESULTS The baseline characteristics of patients in the New-RF and Habib-4X groups had no significant difference (p > 0.05). Compared to Habib-4X, the New-RF had a faster average speed of liver transection (4.81 ± 1.20 cm2/min vs 3.64 ± 1.08 cm2/min, p < 0.001), a narrower width of coagulation tissue (1.42 ± 0.23 cm2 vs 1.81 ± 0.20 cm2, p < 0.001), a less operation time (55.04 ± 16.12 min vs 64.02 ± 15.09 min, p = 0.010), a lower rate of needle path bleeding (13.3% vs 35.0%, p = 0.019), and a lower carbonization rate of electrode needle (22.2% vs 77.8%, p < 0.001). Hemorrhage during the transection (85.0 ml vs 105.0 ml, p = 0.438) and hemorrhage per square centimeter (3.28 ± 0.86 ml/cm2 vs 3.60 ± 1.12 ml/cm2, p = 0.141) in the New-RF group were smaller than those in Habib-4X group with no significant difference. CONCLUSION The new internal cold circulation bipolar radiofrequency was a safe and efficacious auxiliary device for liver resection with a faster speed of resection, lower carbonization rate of electrode needle, and more precise range of coagulation.
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Affiliation(s)
- Yanzhao Zhou
- Department of Hepatopancreatobiliary Surgery, The Affiliated Tumor Hospital of Zhengzhou University, Henan, People's Republic of China
| | - Jingzhong Ouyang
- Department of Hepatopancreatobiliary Surgery, The Affiliated Tumor Hospital of Zhengzhou University, Henan, People's Republic of China
| | - Zhengzheng Wang
- Department of Hepatopancreatobiliary Surgery, The Affiliated Tumor Hospital of Zhengzhou University, Henan, People's Republic of China
| | - Xun Chen
- Department of Hepatopancreatobiliary Surgery, The Affiliated Tumor Hospital of Zhengzhou University, Henan, People's Republic of China
| | - Ruili Zhu
- Department of Hepatopancreatobiliary Surgery, The Affiliated Tumor Hospital of Zhengzhou University, Henan, People's Republic of China
| | - Qingjun Li
- Department of Hepatopancreatobiliary Surgery, The Affiliated Tumor Hospital of Zhengzhou University, Henan, People's Republic of China
| | - Jinxue Zhou
- Department of Hepatopancreatobiliary Surgery, The Affiliated Tumor Hospital of Zhengzhou University, Henan, People's Republic of China
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Hsiao CY, Yang PC, Huang KW. Linear radiofrequency ablation using dual switching-control mode achieves rapid and bloodless liver resection, an experimental research. Int J Hyperthermia 2021; 38:357-362. [PMID: 33641575 DOI: 10.1080/02656736.2021.1892215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/19/2021] [Accepted: 02/13/2021] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Radiofrequency (RF)-assisted devices are widely used for hemostasis during liver resection. This study compared the use of dual switching (DS) versus single switching (SS) control modes for RF-based liver resections in a pig model. METHODS The RF-based system comprised a 200-W generator and three electrodes with 4-cm tips arranged in a linear configuration using an adaptor. Eight Lanyu pigs were used to assess ablation outcomes with electrode spacing of 2 or 3 cm, and ablation durations of 1.5, 2 or 3 min. All combinations were tested in DS and SS modes. Procedures were performed on left lateral, caudal and right anterior liver lobes, and after which transections were performed using a scalpel. Blood loss, complete ablation rate and ablation speed were compared. RESULTS DS mode was shown to induce significantly less blood loss than SS mode when the electrode spacing was set at 2 cm and the ablation duration was 2 min or 3 min (p=.010 and .012, respectively). Extended ablation duration and narrow electrode spacing tended to induce less blood loss, regardless of operating mode. Bloodless resection was achieved using DS mode with electrode spacing of 2 cm and ablation duration of 2-3 min. The highest rate of complete ablation (11.3 cm2/min) was achieved using DS mode with electrode spacing of 2 cm and ablation duration of 1.5 min. CONCLUSION RF-based hepatic resection using DS mode is safe and feasible, resulting in less blood loss than SS mode with a higher rate of complete ablation (i.e., superior ablation efficiency).
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Affiliation(s)
- Chih-Yang Hsiao
- College of Medicine, Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
- Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Chih Yang
- College of Medicine, Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan
- Center for Organ Transplantation and Liver Disease Treatment, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Kai-Wen Huang
- College of Medicine, Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
- Centre of Mini-invasive Interventional Oncology, National Taiwan University Hospital, Taipei, Taiwan
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Barth RJ, Mills JB, Suriawinata AA, Putra J, Tosteson TD, Axelrod D, Freeman R, Whalen GF, LaFemina J, Tarczewski SM, Kinlaw WB. Short-term Preoperative Diet Decreases Bleeding After Partial Hepatectomy: Results From a Multi-institutional Randomized Controlled Trial. Ann Surg 2019; 269:48-52. [PMID: 29489484 DOI: 10.1097/sla.0000000000002709] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Our previous case series suggested that a 1-week, low-calorie and low-fat diet was associated with decreased intraoperative blood loss in patients undergoing liver surgery. OBJECTIVE The current study evaluates the effect of this diet in a randomized controlled trial. METHODS We randomly assigned 60 patients with a body mass index ≥25 kg/m(2) to no special diet or an 800-kcal, 20 g fat, and 70 g protein diet for 1 week before liver resection. Surgeons were blinded to diet assignment. Hepatic glycogen stores were evaluated using periodic acid Schiff (PAS) stains. RESULTS Ninety four percent of the patients complied with the diet. The diet group consumed fewer daily total calories (807 vs 1968 kcal, P < 0.001) and fat (21 vs 86 g, P < 0.001) than the no diet group. Intraoperative blood loss was less in the diet group: mean blood loss 452 vs 863 mL (P = 0.021). There was a trend towards decreased transfusion in the diet group (138 vs 322 mL, P = 0.06). The surgeon judged the liver to be easier to manipulate in the diet group: 1.86 versus 2.90, P = 0.004. Complication rate (20% vs 17%), length of stay (median 5 vs 4 days) and mortality did not differ between groups. There was no difference in hepatic steatosis between groups. There was less glycogen in hepatocytes in the diet group (PAS stain score 1.61 vs 2.46, P < 0.0001). CONCLUSIONS A short-course, low-fat, and low-calorie diet significantly decreases bleeding and makes the liver easier to manipulate in hepatic surgery.
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Affiliation(s)
- Richard J Barth
- Departments of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Jeannine B Mills
- Departments of Radiation Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | - Juan Putra
- Departments of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Tor D Tosteson
- Departments of Biomedical Data Science, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - David Axelrod
- Departments of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Richard Freeman
- Departments of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Giles F Whalen
- Department of Surgery, University of Massachusetts Medical Center, Worcester, MA
| | - Jennifer LaFemina
- Department of Surgery, University of Massachusetts Medical Center, Worcester, MA
| | - Susan M Tarczewski
- Departments of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - William B Kinlaw
- Departments of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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Jayant K, Sodergren MH, Reccia I, Kusano T, Zacharoulis D, Spalding D, Pai M, Jiao LR, Huang KW. A Systematic Review and Meta-Analysis Comparing Liver Resection with the Rf-Based Device Habib™-4X with the Clamp-Crush Technique. Cancers (Basel) 2018; 10:428. [PMID: 30413094 PMCID: PMC6266432 DOI: 10.3390/cancers10110428] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 10/25/2018] [Accepted: 11/01/2018] [Indexed: 02/06/2023] Open
Abstract
Liver cancer is the sixth most common cancer and third most common cause of cancer-related mortality. Presently, indications for liver resections for liver cancers are widening, but the response is varied owing to the multitude of factors including excess intraoperative bleeding, increased blood transfusion requirement, post-hepatectomy liver failure and morbidity. The advent of the radiofrequency energy-based bipolar device Habib™-4X has made bloodless hepatic resection possible. The radiofrequency-generated coagulative necrosis on normal liver parenchyma provides a firm underpinning for the bloodless liver resection. This meta-analysis was undertaken to analyse the available data on the clinical effectiveness or outcomes of liver resection with Habib™-4X in comparison to the clamp-crush technique. The RF-assisted device Habib™-4X is considered a safe and feasible modality for liver resection compared to the clamp-crush technique owing to the multitude of benefits and mounting clinical evidence supporting its role as a superior liver resection device. The most intriguing advantage of the RF-device is its ability to induce systemic and local immunomodulatory changes that further expand the boundaries of survival outcomes following liver resection.
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Affiliation(s)
- Kumar Jayant
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK.
| | - Mikael H Sodergren
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK.
| | - Isabella Reccia
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK.
| | - Tomokazu Kusano
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK.
| | - Dimitris Zacharoulis
- Department of General Surgery, University Hospital of Larissa, Mezourlo, 413 34 Larissa, Greece.
| | - Duncan Spalding
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK.
| | - Madhava Pai
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK.
| | - Long R Jiao
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK.
| | - Kai Wen Huang
- Department of Surgery and Hepatitis Research Center, National Taiwan University Hospital, Taipei 100, Taiwan.
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Reccia I, Sodergren MH, Jayant K, Kurz E, Carneiro A, Spalding D, Pai M, Jiao L, Habib N. The journey of radiofrequency-assisted liver resection. Surg Oncol 2018; 27:A16-A18. [PMID: 29449067 DOI: 10.1016/j.suronc.2018.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 02/08/2023]
Affiliation(s)
- Isabella Reccia
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Mikael H Sodergren
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK.
| | - Kumar Jayant
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Elena Kurz
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Adriano Carneiro
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Duncan Spalding
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Madhava Pai
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Long Jiao
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Nagy Habib
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK.
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Vavra P, Karnik L, Skrobankova M, Jurcikova J, Ihnat P, Zonca P, Peteja M, El-Gendi A, Czudek S. Advancement in liver laparoscopic resection - development of a new surgical device. ACTA ACUST UNITED AC 2018. [PMID: 29513788 PMCID: PMC5856430 DOI: 10.1590/1414-431x20176062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Liver resection is the standard treatment for any liver lesion. Laparoscopic liver
resection is associated with lower intra-operative blood loss and fewer complications
than open resection. Access to the posterior part of the right liver lobe is very
uncomfortable and difficult for surgeons due the anatomic position, especially when
employing laparoscopic surgery. Based on these experiences, a new laparoscopic device
was developed that is capable of bending its long axis and allowing the application
of radiofrequency energy in areas that were not technically accessible. The device is
equipped with four telescopic needle electrodes that cause tissue coagulation after
the delivery of radiofrequency energy. Ex vivo testing was performed
in 2012 and 2014 at the University Hospital, Ostrava, on a porcine liver tissue. The
main goal of this testing was to verify if the newly proposed electrode layout was
suitable for sufficient tissue coagulation and creating a safety zone around lesions.
During the ex vivo testing, the material of needle electrodes was
improved to achieve the lowest possibility of adhesion. The power supply was adjusted
from 20 to 120 W and the ablation time, which varied from 10 to 110 s, was monitored.
Subsequently, optimal power delivery and time for coagulation was determined. This
experimental study demonstrated the feasibility and safety of the newly developed
device. Based on the ex vivo testing, LARA-K1 can create a safety
zone of coagulation. For further assessment of the new device, an in
vivo study should be performed.
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Affiliation(s)
- P Vavra
- Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Department of Surgery, University Hospital Ostrava, Ostrava, Czech Republic.,Department of Cybernetics and Biomedical Engineering, Faculty of Electrical Engineering and Computer Science, VSB-Technical University of Ostrava, Ostrava, Czech Republic
| | - L Karnik
- Department of Robotic, Faculty of Mechanical Engineering, VSB-Technical University of Ostrava, Ostrava, Czech Republic
| | - M Skrobankova
- Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Department of Internal Medicine, University Hospital of Ostrava, Ostrava, Czech Republic
| | - J Jurcikova
- Department of Vice-President for Science and Research, University Hospital Ostrava, Ostrava, Czech Republic
| | - P Ihnat
- Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Department of Surgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - P Zonca
- Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Department of Surgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - M Peteja
- Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Department of Surgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - A El-Gendi
- Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - S Czudek
- Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Department of Surgery, University Hospital Ostrava, Ostrava, Czech Republic
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Chen ZB, Qin F, Ye Z, Shen SQ, Li W, Ding YM, Hu QY, Ma Y. Microwave-assisted liver resection vs. clamp crushing liver resection in cirrhosis patients with hepatocellular carcinoma. Int J Hyperthermia 2018; 34:1359-1366. [PMID: 29353503 DOI: 10.1080/02656736.2018.1429678] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE This study aimed to evaluate the safety and effectiveness of microwave-ablation-assisted liver resection (MW-LR) and clamp crushing liver resection (CC-LR) in cirrhotic patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS From July 2005 to January 2015, cirrhotic HCC patients who underwent CC-LR (n = 191) or MW-LR (n = 112) were retrospectively analysed. We compared morbidity, mortality, disease-free survival (DFS) time and overall survival time between the CC-LR and MW-LR groups. RESULTS The blood loss volume was significantly higher in the CC-LR group (mean of 752 ml) than that in the MW-LR group (mean of 253 ml, p < 0.001). The abdominal abscess rate was higher in the MW-LR group (8.9%) than that in the CC-LR group (3.1%, p = 0.029). The 30-day mortality rate (1.5% vs. 0.8%) and postoperative complication rate (32.9% vs. 25.0%) were both similar between the CC-LR and MW-LR groups. MW-LR provided a survival benefit over CC-LR at 1, 3 and 5 years in the entire population (93.5% vs. 87.0%, 77.0% vs. 62.5% and 50.0% vs. 36.5%, respectively; p = 0.003). In a subgroup analysis, MW-LR provided a survival benefit over CC-LR for Barcelona Clinic Liver Cancer stage A (BCLC-A) HCC (p = 0.026) and stage B (BCLC-B) HCC (p = 0.035) patients and provided DFS benefits for BCLC-A HCC patients (p = 0.036). CONCLUSIONS MW-LR is a safe and feasible procedure for HCC patients with a cirrhotic liver history.
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Affiliation(s)
- Zu-Bing Chen
- a Department of General Surgery , Renmin Hospital of Wuhan University , Wuhan , China
| | - Feng Qin
- a Department of General Surgery , Renmin Hospital of Wuhan University , Wuhan , China
| | - Zi Ye
- a Department of General Surgery , Renmin Hospital of Wuhan University , Wuhan , China
| | - Shi-Qiang Shen
- a Department of General Surgery , Renmin Hospital of Wuhan University , Wuhan , China
| | - Wei Li
- a Department of General Surgery , Renmin Hospital of Wuhan University , Wuhan , China
| | - You-Ming Ding
- a Department of General Surgery , Renmin Hospital of Wuhan University , Wuhan , China
| | - Qin-Yong Hu
- b Department of Oncology , Renmin Hospital of Wuhan University , Wuhan , China
| | - Yi Ma
- c Department of General Surgery , The First Affiliated Hospital, Sun Yat-Sen University , Guangzhou , China
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11
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Huang KW, Lee PH, Kusano T, Reccia I, Jayant K, Habib N. Impact of cavitron ultrasonic surgical aspirator (CUSA) and bipolar radiofrequency device (Habib-4X) based hepatectomy for hepatocellular carcinoma on tumour recurrence and disease-free survival. Oncotarget 2017; 8:93644-93654. [PMID: 29212179 PMCID: PMC5706825 DOI: 10.18632/oncotarget.21271] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 09/08/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The aim of this study was to evaluate the oncological outcomes of hepatocellular carcinoma patients undergoing liver resection using cavitron ultrasonic surgical aspirator (CUSA) or radiofrequency (RF) based device Habib-4X.
. STUDY DESIGN We prospectively analyzed the data of 280 patients who underwent liver resection for hepatocellular carcinoma at our institution from 2010-2012 with follow up till August 2016. The CUSA was used in the 163 patients whilst Habib-4X in 117 patients. The end points of analysis were oncological outcomes as disease recurrence, disease-free survival (DFS) and overall survival (OS) were estimated by the Kaplan-Meier method, which has been compared with all other existing literature on the survival study. RESULTS Compared with CUSA the reported incidence of recurrence was significantly lower, in Habib-4X group; p < 0.01. The median DFS was significantly better in Habib-4X group than CUSA group (50.80 vs 45.87 months, p = 0.03). The median OS was better in Habib-4X group than CUSA group (60.57 vs 57.17 months, p = 0.12) though the lesser difference in OS between the groups might be explained by the use of palliative therapies as TACE, percutaneous RFA, etc. in case of recurrence. CONCLUSIONS RF based device Habib-4X, is safe and effective device for resection of hepatocellular carcinoma, in comparison to CUSA with better oncological outcomes, i.e., significantly lesser tumour recurrence and better DFS. This could be explained on the basis of systemic and local immunomodulatory effect involving induction of kupffer cells and effector CD-8 T cells that help in minimizing postoperative complications and bring more advantageous oncological outcomes.
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Affiliation(s)
- Kai-Wen Huang
- Department of Surgery & Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
- Centre of Mini-invasive Interventional Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Po-Huang Lee
- Department of Surgery & Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Tomokazu Kusano
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Isabella Reccia
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Kumar Jayant
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Nagy Habib
- Department of Surgery and Cancer, Imperial College London, London, UK
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12
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Ypsilantis P, Lambropoulou M, Milicevic M, Bulajic P, Karayiannakis A, Zacharoulis D, Simopoulos C. Microscopic assessment of the tissue-sparing potential of radiofrequency-assisted liver resection techniques in a porcine model. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2017; 24:657-666. [PMID: 29032589 DOI: 10.1002/jhbp.513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The aim of the present study was to microscopically assess the tissue-sparing potential of contemporary radiofrequency-assisted liver resection (RF-LR) techniques. METHODS Twenty-four pigs were subjected to either (1) partial hepatectomy (PH) using the sequential-coagulate-cut (SCC) technique (group SCC, n = 6) using a monopolar electrode, the technique using the bipolar electrode Habib-4X (group H, n = 6) or the "crush-clamp" technique (group CC, n = 6); or (2) sham operation (group Sham, n = 6). At 48 h post-operation, liver parenchyma proximal to the ablation rim was excised for histopathologic examination and immunohistochemical assessment of apoptosis (antibody M30) and inflammatory response (antibodies IL-6, TNFα and NFκB). RESULTS Histopathologic index increased from the 1st to the 4th , the 1st to the 2nd or only the 1st cm from the inner margin of the ablation rim in group SCC, H or CC, respectively. The index was higher in group SCC compared to the other groups. Tissue expression of M30, IL-6, TNFα and NFκB increased in all PH groups, being higher and more expanded in group SCC, H, SCC and SCC, respectively. CONCLUSIONS RF-LR techniques had variable microscopically assessed tissue-sparing effect. The Habib-4X proved to be less injurious compared to the SCC Belgrade technique regarding the severity and extent of tissue damage proximal to the ablation rim.
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Affiliation(s)
- Petros Ypsilantis
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Maria Lambropoulou
- Laboratory of Histology and Embryology, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Miroslav Milicevic
- First Surgical Clinic, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Predrag Bulajic
- First Surgical Clinic, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Anastasios Karayiannakis
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimitrios Zacharoulis
- Clinic of Surgery, School of Medicine, University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Constantinos Simopoulos
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
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Hamada T, Nanashima A, Yano K, Sumida Y, Hiyoshi M, Imamura N, Tobinaga S, Tsuchimochi Y, Takeno S, Fujii Y, Nagayasu T. Significance of a soft-coagulation system with monopolar electrode for hepatectomy: A retrospective two-institution study by propensity analysis. Int J Surg 2017; 45:149-155. [PMID: 28774659 DOI: 10.1016/j.ijsu.2017.07.101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 07/25/2017] [Accepted: 07/27/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND The VIO soft-coagulation system (VIO) with a monopolar electrode is a novel hemostatic device that provides hemostasis by superficial contact at the bleeding site without carbonization. Because heat injury remains a concern, surgical records and postoperative liver dysfunction were retrospectively evaluated in a cohort study. METHODS Between September 2010 and March 2016, 322 patients underwent hepatectomy in which hemostatic devices were used at two institutions. Surgical results with use of VIO at one institute (VIO group) were compared with those without use of VIO at a second institute (control group), and propensity analysis was performed. RESULTS In limited resection and segmentectomy or sectionectomy performed in the VIO group, the prevalence of liver cirrhosis was significantly higher and the operation time was significantly longer in comparison with the control group (p < 0.05). In all hepatectomies, postoperative levels of total bilirubin and aspartate or alanine transaminase tended to be increased and prothrombin activity tended to be lower in the VIO group in comparison with the control group (p < 0.05). The prevalence of hepatic failure in the VIO group was significantly higher in comparison with that in the control group (p < 0.05). In cases of segmentectomy or sectionectomy, blood loss was significantly increased in the VIO group in comparison with that in the control group (p < 0.05) Propensity score matching showed that although the surgical records and outcomes were not significantly different between the groups, postoperative liver dysfunction was significant in the VIO group in comparison with the control group (p < 0.05). CONCLUSIONS Mild postoperative hepatic thermal injury with VIO was confirmed, and therefore, surgeons should take care when using the VIO system to make frequent wide resected cuts on the surface of the liver.
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Affiliation(s)
- Takeomi Hamada
- Division of Hepato-biliary-pancreas Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Atsushi Nanashima
- Division of Hepato-biliary-pancreas Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan; Division of Gastrointestinal, Endocrine and Pediatric Surgery, Department of Surgery, University of Miyazaki, Faculty of Medicine, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan; Department of Surgical Oncology, Nagasaki University School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Koichi Yano
- Division of Hepato-biliary-pancreas Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Yorihisa Sumida
- Department of Surgical Oncology, Nagasaki University School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - Masahide Hiyoshi
- Division of Hepato-biliary-pancreas Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Naoya Imamura
- Division of Hepato-biliary-pancreas Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Shuichi Tobinaga
- Department of Surgical Oncology, Nagasaki University School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - Yuki Tsuchimochi
- Division of Hepato-biliary-pancreas Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Shinsuke Takeno
- Division of Gastrointestinal, Endocrine and Pediatric Surgery, Department of Surgery, University of Miyazaki, Faculty of Medicine, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Yoshiro Fujii
- Division of Hepato-biliary-pancreas Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
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Harada K, Chiba A, Mizonobe K, Numasawa K, Imai T. Optimization of the Timing of the Portal Venous Phase in Preoperative 3DCT for Malignant Liver Tumors. Nihon Hoshasen Gijutsu Gakkai Zasshi 2016; 72:1098-1104. [PMID: 27867169 DOI: 10.6009/jjrt.2016_jsrt_72.11.1098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Preoperative three-dimensional computed tomography (3DCT) of the liver is the most important examination in performing preoperative simulation. Detailed visualization of the portal vein using the workstation is critical to enable accurate liver segmentation. However, the timing of imaging in the portal venous phase has mostly been reported equivalent to that of the liver screening examinations commonly performed. The purpose of this study was to examine the optimal timing of image capture to create the best portal vein visualization in preoperative 3DCT of the liver. Seventy-nine patients who underwent hepatectomy for malignant liver tumors were enrolled in this study. All patients were preoperatively examined using protocol A (imaging method separated into a portal venous phase and a hepatic venous phase) and then examined 1 week after surgery using protocol B (normal liver screening protocol). We first established the regions of interest in the portal vein and the hepatic vein and then compared CT values for these regions under protocol A and protocol B. The average CT value of the portal vein in protocol A and B was 239.8±28.1 HU and 202.2±18.5 HU, respectively. The average CT value of the portal vein in protocol A was significantly higher compared with protocol B (p<0.01). By introducing separate timing for portal venous phase imaging before preoperative 3DCT (protocol A), it is possible to satisfactorily depict the portal vein.
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Affiliation(s)
- Kohei Harada
- Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital
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15
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Palumbo G, Iadicicco A, Tosi D, Verze P, Carlomagno N, Tammaro V, Ippolito J, Campopiano S. Temperature profile of ex-vivo organs during radio frequency thermal ablation by fiber Bragg gratings. JOURNAL OF BIOMEDICAL OPTICS 2016; 21:117003. [PMID: 27846343 DOI: 10.1117/1.jbo.21.11.117003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 10/19/2016] [Indexed: 05/19/2023]
Abstract
We report on the integration of fiber optic sensors with commercial medical instrumentation for temperature monitoring during radio frequency ablation for tumor treatment. A suitable configuration with five fiber Bragg grating sensors bonded to a bipolar radio frequency (RF) probe has been developed to monitor the area under treatment. A series of experiments were conducted on <italic<ex-vivo</italic< animal kidney and liver and the results confirm that we were able to make a multipoint measurement and to develop a real-time temperature profile of the area, with a temperature resolution of 0.1°C and a spatial resolution of 5 mm during a series of different and consecutive RF discharges.
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Affiliation(s)
- Giovanna Palumbo
- University of Naples "Parthenope", Centro Direzionale Isola C4, Naples 80143, Italy
| | - Agostino Iadicicco
- University of Naples "Parthenope", Centro Direzionale Isola C4, Naples 80143, Italy
| | - Daniele Tosi
- Nazarbayev University, School of Engineering, 53 Kabanbay Batyz Avenue, Astana 010000, Kazakhstan
| | - Paolo Verze
- Azienda Ospedaliera Universitaria Federico II of Naples, Urology Unit, Via S. Pansini 5, Naples 80131, Italy
| | - Nicola Carlomagno
- Azienda Ospedaliera Universitaria Federico II of Naples, General Surgery and Transplant Unit, Via S. Pansini 5, Naples 80131, Italy
| | - Vincenzo Tammaro
- Azienda Ospedaliera Universitaria Federico II of Naples, General Surgery and Transplant Unit, Via S. Pansini 5, Naples 80131, Italy
| | - Juliet Ippolito
- Azienda Ospedaliera Universitaria Federico II of Naples, Urology Unit, Via S. Pansini 5, Naples 80131, Italy
| | - Stefania Campopiano
- University of Naples "Parthenope", Centro Direzionale Isola C4, Naples 80143, Italy
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16
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Guo R, Feng X, Xiao S, Yan J, Xia F, Ma K, Li X. Short- and long-term outcomes of hepatectomy with or without radiofrequency-assist for the treatment of hepatocellular carcinomas: a retrospective comparative cohort study. Biosci Trends 2015; 9:65-72. [PMID: 25787911 DOI: 10.5582/bst.2014.01142] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The objective of this study was to compare the short- and long-term outcomes of radiofrequency-assisted liver resection (RFLR) and conventional clamp-crushing liver resection (CCLR) and to evaluate the safety and efficiency of RFLR. Between January 2008 and December 2012, a total of 597 patients with hepatocellular carcinoma (HCC) who underwent curative hepatectomy were identified. A total of 272 patients underwent RFLR, and 325 patients received CCLR. The short- and long-term outcomes were compared. The patients in the RFLR and CCLR groups showed similar baseline characteristics. The RFLR group showed less intraoperative blood loss (485.5 vs. 763.2 mL, p = 0.003), a lower transfusion requirement rate (19.1 vs. 31.7%, p ≤ 0.01), shorter surgery duration (211 vs. 296 min, p ≤ 0.01) and a lower vascular inflow occlusion rate (25.7 vs. 33.8%, p = 0.032). No significant postoperative changes in bilirubin or liver enzymes were observed in the two groups. The degree of postoperative complications and morbidity did not significantly differ between the two groups. There were no significant differences in the 1-, 2- and 3-year overall survival rates (73.8%, 58.5%, and 55.7% vs. 80.8%, 65.8%, and 56.2%, respectively) or disease-free rates (51.9%, 47.2%, and 46.0% vs. 54.5%, 44.9%, and 38.5%, respectively) between the RFLR and CCLR groups. These results suggested RFLR was a safe and efficient method for patients with HCC. RFLR was associated with decreased blood loss, fewer blood transfusions, shorter surgery times and less vascular inflow occlusion application. The RFLR group did not show increased liver injury or postoperative morbidity or mortality.
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Affiliation(s)
- Rui Guo
- Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University
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17
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Zhang F, Yan J, Feng XB, Xia F, Li XW, Ma KS, Bie P. Efficiency and safety of radiofrequency-assisted hepatectomy for hepatocellular carcinoma with cirrhosis: A single-center retrospective cohort study. World J Gastroenterol 2015; 21:10159-10165. [PMID: 26401080 PMCID: PMC4572796 DOI: 10.3748/wjg.v21.i35.10159] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 03/27/2015] [Accepted: 04/17/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the efficiency and safety of radiofrequency-assisted hepatectomy in patients with hepatocellular carcinoma (HCC) and cirrhosis.
METHODS: From January 2010 to December 2013, 179 patients with HCC and cirrhosis were recruited for this retrospective study. Of these, 100 patients who received radiofrequency-assisted hepatectomy (RF+ group) were compared to 79 patients who had hepatectomy without ablation (RF- group). The primary endpoint was intraoperative blood loss. The secondary endpoints included liver function, postoperative complications, mortality, and duration of hospital stay.
RESULTS: The characteristics of the two groups were closely matched. The Pringle maneuver was not used in the RF+ group. There was significantly less median intraoperative blood loss in the RF+ group (300 vs 400 mL, P = 0.01). On postoperative days (POD) 1 and 5, median alanine aminotransferase was significantly higher in the RF+ group than in the RF- group (POD 1: 348.5 vs 245.5, P = 0.01; POD 5: 112 vs 82.5, P = 0.00), but there was no significant difference between the two groups on POD 3 (260 vs 220, P = 0.24). The median AST was significantly higher in the RF+ group on POD 1 (446 vs 268, P = 0.00), but there was no significant difference between the two groups on POD 3 and 5 (POD 3: 129.5 vs 125, P = 0.65; POD 5: 52.5 vs 50, P = 0.10). Overall, the rate of postoperative complications was roughly the same in these two groups (28.0% vs 17.7%, P = 0.11) except that post hepatectomy liver failure was far more common in the RF+ group than in the RF- group (6% vs 0%, P = 0.04).
CONCLUSION: Radiofrequency-assisted hepatectomy can reduce intraoperative blood loss during liver resection effectively. However, this method should be used with caution in patients with concomitant cirrhosis because it may cause severe liver damage and liver failure.
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18
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Gomaa AI, Waked I. Recent advances in multidisciplinary management of hepatocellular carcinoma. World J Hepatol 2015; 7:673-87. [PMID: 25866604 PMCID: PMC4388995 DOI: 10.4254/wjh.v7.i4.673] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 12/17/2014] [Accepted: 01/15/2015] [Indexed: 02/06/2023] Open
Abstract
The incidence of hepatocellular carcinoma (HCC) is increasing, and it is currently the second leading cause of cancer-related death worldwide. Potentially curative treatment options for HCC include resection, transplantation, and percutaneous ablation, whereas palliative treatments include trans-arterial chemoembolization (TACE), radioembolization, and systemic treatments. Due to the diversity of available treatment options and patients' presentations, a multidisciplinary team should decide clinical management of HCC, according to tumor characteristics and stage of liver disease. Potentially curative treatments are suitable for very-early- and early-stage HCC. However, the vast majority of HCC patients are diagnosed in later stages, where the tumor characteristics or progress of liver disease prevent curative interventions. For patients with intermediate-stage HCC, TACE and radioembolization improve survival and are being evaluated in addition to potentially curative therapies or with systemic targeted therapy. There is currently no effective systemic chemotherapy, immunologic, or hormonal therapy for HCC, and sorafenib is the only approved molecular-targeted treatment for advanced HCC. Other targeted agents are under investigation; trials comparing new agents in combination with sorafenib are ongoing. Combinations of systemic targeted therapies with local treatments are being evaluated for further improvements in HCC patient outcomes. This article provides an updated and comprehensive overview of the current standards and trends in the treatment of HCC.
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Affiliation(s)
- Asmaa I Gomaa
- Asmaa I Gomaa, Imam Waked, Hepatology Department, National Liver Institute, Menoufiya University, Shebeen El-Kom 35111, Egypt
| | - Imam Waked
- Asmaa I Gomaa, Imam Waked, Hepatology Department, National Liver Institute, Menoufiya University, Shebeen El-Kom 35111, Egypt
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19
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Xiao WK, Chen D, Hu AB, Peng BG, Guo YZ, Fu SJ, Liang LJ, Li SQ. Radiofrequency-assisted versus clamp-crush liver resection: a systematic review and meta-analysis. J Surg Res 2014; 187:471-83. [DOI: 10.1016/j.jss.2013.10.055] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 10/21/2013] [Accepted: 10/25/2013] [Indexed: 12/20/2022]
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20
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Vrochides D, Kardassis D, Ntinas A, Miliaras D, Papalois A, Magnissalis E, Metrakos P. A novel liver parenchyma transection technique using locking straight rigid ties. An experimental study in pigs. J INVEST SURG 2013; 27:106-13. [PMID: 24063662 DOI: 10.3109/08941939.2013.832825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Technological advances have led to the development of many devices used in liver resections. However, no single transection tool is uniformly considered to be better than the others. This study aimed to develop an effective, fast, and cost-efficient technique for hepatic parenchymal transection. MATERIALS AND METHODS A liver parenchyma compression device in the form of a locking straight rigid tie (LoStRiT) was newly developed. Twelve pigs were distributed into two groups. The control group ( n = 6) comprised animals that underwent hepatectomy using the standard Kelly-clysis technique. The study group (n = 6) comprised animals that underwent hepatectomy using sequential LoStRiT mechanisms. The transection speed, blood loss, and biloma formation were recorded. RESULTS The mean parenchymal transection speed was 1.27 ± 0.27 cm(2)/min for the control group and 2.39 ± 0.56 cm(2)/min for the LoStRiT group ( p = .003). The mean blood loss per kilogram of body weight was 9.8 ± 5.2 ml/kg for the control group and 3.9 ± 0.9 ml/kg for the LoStRiT group ( p = .040). No bilomas were identified. CONCLUSION LoStRiT hepatectomy appears to be effective, fast, and reproducible in a porcine model of liver resection. Further development of this novel and potentially cost-efficient technique includes construction of the device using absorbable materials.
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Affiliation(s)
- Dionisios Vrochides
- Hepato-Pancreato-Biliary & Transplant Division, Department of Surgery, McGill University , Montreal, QC , Canada
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21
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Nanashima A, Abo T, Arai J, Takagi K, Matsumoto H, Takeshita H, Tsuchiya T, Nagayasu T. Usefulness of vessel-sealing devices combined with crush clamping method for hepatectomy: a retrospective cohort study. Int J Surg 2013; 11:891-7. [PMID: 23954369 DOI: 10.1016/j.ijsu.2013.07.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 07/10/2013] [Accepted: 07/26/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Blood loss during resection of the hepatic parenchyma in hepatectomy can be minimized using vessel-sealing (VS) devices. Some sealing devices were retrospectively compared to evaluate the efficacy of each device for controlling blood loss, transection time and postoperative complications in hepatectomy as a cohort study. METHODS Between 2005 and September 2012, hepatectomy was underwent in 150 patients using one of three types of LigaSure™ (Dolphin Tip Laparoscopic Instrument, Precise or Small Jaw) or the Harmonic Focus or Ace ultrasonic dissecting sealer. Results were compared to crush-clamping alone as the control method by the historical study (n = 81). RESULTS Irrespective of the vessel-sealing device used for underlying chronic hepatitis, blood loss, blood transfusion rate, operating time and transection time were significantly reduced in the VS group compared with controls (p < 0.05). Rates of postoperative bile leakage and intra-abdominal abscess formation were significantly lower in the VS group than in controls (p < 0.05). Comparing devices, LigaSure Small Jaw and Harmonic Focus showed lower blood loss, shorter transection time and reduced rates of post-hepatectomy complications, in turn resulting in shorter hospital stays (p < 0.05). Tendencies toward uncontrolled ascites and bile leakage were only concern with the use of Harmonic Focus. Satisfactory surgical results were achieved using the sealing device for laparoscopic hepatectomy. CONCLUSIONS The use of energy sealing devices improves surgical results and avoids hepatectomy-related complications. Adequate use of vessel sealers is necessary for safe and rapid completion of hepatic resection.
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Affiliation(s)
- Atsushi Nanashima
- Division of Surgical Oncology and Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Japan.
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22
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Ihnát P, Ihnát Rudinská L, Zonča P. Radiofrequency energy in surgery: state of the art. Surg Today 2013; 44:985-91. [PMID: 23728491 DOI: 10.1007/s00595-013-0630-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 04/30/2013] [Indexed: 12/30/2022]
Abstract
Over a period of more than 100 years, radiofrequency energy has been introduced in many fields and applications in medicine. At present, radiofrequency constitutes the basis of numerous medical devices employed in almost all medical specialties. It is particularly applicable and valuable in various minimally invasive procedures for its locally focused effects. Radiofrequency energy is a technical term established to describe high-frequency alternating electrical currents (with a frequency ranging from 300 kHz to 3 MHz) and their impact on biological tissue. The application of RF energy causes controlled tissue heating with consequent cell protein denaturation and desiccation, which leads to cell death and tissue destruction. The primary principle of radiofrequency is that the generated heat can be used to cut, coagulate or induce metabolic processes in the target tissue. The authors of this paper offer a comprehensive and compact review of the definition, history, physics, biological principles and applications of radiofrequency energy in current surgery.
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Affiliation(s)
- Peter Ihnát
- Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00, Ostrava, Czech Republic,
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23
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Arya S, Hadjievangelou N, Lei S, Kudo H, Goldin RD, Darzi AW, Elson DS, Hanna GB. Radiofrequency-induced small bowel thermofusion: an ex vivo study of intestinal seal adequacy using mechanical and imaging modalities. Surg Endosc 2013; 27:3485-96. [PMID: 23572219 DOI: 10.1007/s00464-013-2935-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 03/12/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Bipolar radiofrequency (RF) induced tissue fusion is believed to have the potential to seal and anastomose intestinal tissue thereby providing an alternative to current techniques which are associated with technical and functional complications. This study examines the mechanical and cellular effects of RF energy and varying compressive pressures when applied to create ex vivo intestinal seals. METHODS A total of 299 mucosa-to-mucosa fusions were formed on ex vivo porcine small bowel segments using a prototype bipolar RF device powered by a closed-loop, feedback-controlled RF generator. Compressive pressures were increased at 0.05 MPa intervals from 0.00 to 0.49 MPa and RF energy was applied for a set time period to achieve bowel tissue fusion. Seal strength was subsequently assessed using burst pressure and tensile strength testing, whilst morphological changes were determined through light microscopy. To further identify the subcellular tissue changes that occur as a result of RF energy application, the collagen matrix in the fused area of a single bowel segment sealed at an optimal pressure was examined using transmission electron microscopy (TEM). RESULTS An optimal applied compressive pressure range was observed between 0.10 and 0.25 MPa. Light microscopy demonstrated a step change between fused and unfused tissues but was ineffective in distinguishing between pressure levels once tissues were sealed. Non uniform collagen damage was observed in the sealed tissue area using TEM, with some areas showing complete collagen denaturation and others showing none, despite the seal being complete. This finding has not been described previously in RF-fused tissue and may have implications for in vivo healing. CONCLUSIONS This study shows that both bipolar RF energy and optimal compressive pressures are needed to create strong intestinal seals. This finding suggests that RF fusion technology can be effectively applied for bowel sealing and may lead to the development of novel anastomosis tools.
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Affiliation(s)
- Shobhit Arya
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, 10th Floor, QEQM Building, South Wharf Road, London W2 1NY, UK.
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Pesi B, Leo F, Liscia G, Alemanno G, Zambonin D, Falchini M, Batignani G. Radiofrequency on the liver remnant after liver resection to reach the haemostasis not otherwise achievable with conventional techniques. Int J Surg Case Rep 2013; 4:558-60. [PMID: 23632073 DOI: 10.1016/j.ijscr.2013.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 02/18/2013] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION During liver resection, in same case of inflamed, steatotic or neo-vascularized liver parenchyma, reaching of haemostasis on the liver resection surface could be very difficult for the surgeon because of the presence of fragile tissue that does not allows the proper placement of stitches, and the conventional method fail. PRESENTATION OF CASE The authors describe a novel technique in which, after a formal liver resection, liver haemostasis is achieved using radiofrequency energy on the resected surface. A patient affected by a hystiocytic sarcoma localized on the VI-V and IVa segments was scheduled for liver resection. During the resection a diffuse bleeding from the resected surface started with little success obtained with conventional method. So we decided to use the coagulative necrosis generated by the radiofrequency, using a cool type cluster needle, hand-piece with 3 needle, bending 2 needles in a way resembling a "fork", to reach a complete and definitive haemostasis. DISCUSSION Haemostasis remains a critical issue in liver surgery not only for the catastrophic effect of haemorrhage but also because it is correlated to complications rate and to survival. The coagulative necrosis generated by the radiofrequency could be used to facilitate the creation of a necrotic plane to be transacted. CONCLUSION The use of the radiofrequency energy, delivered through needles, is suggested when the conventional techniques fail to reach a proper haemostasis after a liver resection or, to consider its use, prior to resect the liver in presence of fragile parenchyma.
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Affiliation(s)
- Benedetta Pesi
- Digestive Surgery Unit, Department of Surgery and Traslational Medicine, University of Florence Medical School, Careggi University Hospital, Florence, Italy.
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Li M, Zhang W, Li Y, Li P, Li J, Gong J, Chen Y. Radiofrequency-assisted versus clamp-crushing parenchyma transection in cirrhotic patients with hepatocellular carcinoma: a randomized clinical trial. Dig Dis Sci 2013; 58:835-40. [PMID: 23007732 DOI: 10.1007/s10620-012-2394-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 08/28/2012] [Indexed: 01/22/2023]
Abstract
BACKGROUND Surgical resection remains the optimal therapy for cirrhotic patients with hepatocellular carcinoma (HCC) that are not suitable for liver transplantation (LT). Recently, various innovative techniques for liver resection have been developed. AIM The aim of the study was to compare radiofrequency-assisted parenchyma transection (RF-PT) with the traditional clamp-crushing (CC) technique to explore the preferred therapy in cirrhotic patients with HCC. METHODS From January 2009 to December 2010, 75 cirrhotic patients with HCC who underwent hepatectomy were randomized to RF-PT (group 1, n = 38) or CC-PT (group 2, n = 37) groups. The primary endpoint was intraoperative blood loss. The secondary endpoints included hepatic transection time, total operating time, postoperative morbidity, mortality, length of intensive care unit and hospital stays, and liver function. RESULTS The characteristics of the two patient groups were closely matched. The Pringle maneuver was not used in RF-PT patients. The blood loss of the RF-PT group, total or during transection, was significantly lower than that of the CC-PT group (385 vs. 545 ml, p = 0.001; 105 vs. 260 ml, p = 0.000, respectively). Compared with CC-PT patients, the morbidity of the RF-PT group was lower though not statistically significant (28.9 vs. 38.8 %, p = 0.197). One death occurred in the RF-PT group 12 days postoperative due to a large area cerebral embolism. CONCLUSION RF-PT is a safe and feasible surgical resection method for patients with cirrhosis and concomitant HCC. In addition, RF-PT results in lower blood loss and lower morbidity than the CC technique during liver resection.
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Affiliation(s)
- Min Li
- Department of Hepatobiliary Surgery, 2nd College of Clinical Medicine of Chongqing University of Medical Science, Chongqing, 400010, China.
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Partial spleen resection with a radiofrequency needle device--a pilot study. Langenbecks Arch Surg 2013; 398:449-54. [PMID: 23385735 DOI: 10.1007/s00423-013-1054-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 01/22/2013] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Total splenectomy leads to an immunocompromised state, with an increased lifetime risk of infection. The lifetime risk of developing overwhelming postsplenectomy infection is 5 %, with a mortality rate of approximately 50 %. In addition to vaccination and antibiotic prophylaxis, partial splenectomy is believed to improve patient safety. METHODS We performed partial splenectomy in seven patients using a radiofrequency (RF) technique with Habib® needles. In seven patients, an open access partial splenectomy was performed. In three patients, a partial splenectomy was performed simultaneously with intraabdominal tumour resection. In two patients, the upper pole of the spleen was removed due to tumours of the spleen. In one patient, a large symptomatic splenic cyst was resected and in another patient, a partial splenectomy was performed due to trauma. RF was applied using Habib® needles (AngioDynamics, Manchester, GA, 31816, USA). RESULTS The partial splenectomy procedures were easy and safe in all seven patients. The RF application with the Habib® needles led to primary haemostasis. The blood loss was less than 50 ml in all cases. After a minimum follow-up of 1 year, there were no cases of infections or other adverse events related to the previous partial splenectomy. CONCLUSION In our experience, partial splenectomy with Habib® needles is easy to perform and safe for the patient. Thus, radiofrequency resection is a good alternative to total splenectomy in many patients and reduces the risk of postsplenectomy infections.
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Galizia G, Castellano P, Pinto M, Zamboli A, Orditura M, De Vita F, Pignatelli C, Lieto E. Radiofrequency-assisted liver resection with a comb-shaped bipolar device versus clamp crushing: a clinical study. Surg Innov 2012; 19:407-414. [PMID: 22170895 DOI: 10.1177/1553350611430672] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND In liver surgery, clamp-crushing (CC) procedure has been shown to be the most efficient system for liver transection. Recently, it has been suggested that radiofrequency-assisted liver resection (RFALR) may be more advantageous, but sufficient evidence has yet to be accumulated. METHOD The control group was constituted by 32 patients undergoing CC liver transection. The study group included 13 patients undergoing RFALR with a new fully automated radiofrequency generator supplying a comb-shaped bipolar multielectrode device. RESULTS RFALR allowed a faster hepatic transection and reduced both surgical time and intraoperative blood loss. RFALR was the only independent prognostic indicator of bleeding during liver transection. No significant liver damage and postoperative complications, particularly biliary leakage and stenosis, were experienced in the RFALR group. CONCLUSION Compared with the CC procedure, this bipolar device was shown to be safe and effective in liver resections, allowing a very clean surgical field without increase of postoperative complications.
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Affiliation(s)
- Gennaro Galizia
- Second University of Naples School of Medicine, F. Magrassi-A. Lanzara Department of Clinical and Experimental Medicine and Surgery, c/o II Policlinico, Edificio 17, Via Pansini 5, 80131 Naples, Italy.
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Romano F, Garancini M, Uggeri F, Degrate L, Nespoli L, Gianotti L, Nespoli A, Uggeri F. Bleeding in Hepatic Surgery: Sorting through Methods to Prevent It. HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 2012; 2012:169351. [PMID: 23213268 PMCID: PMC3506885 DOI: 10.1155/2012/169351] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 10/23/2012] [Indexed: 12/22/2022]
Abstract
Liver resections are demanding operations which can have life threatening complications although they are performed by experienced liver surgeons. The parameter "Blood Loss" has a central role in liver surgery, and different strategies to minimize it are a key to improve results. Moreover, recently, new technologies are applied in the field of liver surgery, having one goal: safer and easier liver operations. The aim of this paper is to review the different principal solutions to the problem of blood loss in hepatic surgery, focusing on technical aspects of new devices.
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Affiliation(s)
- Fabrizio Romano
- Unit of Hepatobiliary and Pancreatic Surgery, Department of Surgery, San Gerardo Hospital, University of Milan-Bicocca, Via Donizetti 106, 20052 Monza, Italy
| | - Mattia Garancini
- Unit of Hepatobiliary and Pancreatic Surgery, Department of Surgery, San Gerardo Hospital, University of Milan-Bicocca, Via Donizetti 106, 20052 Monza, Italy
| | - Fabio Uggeri
- Unit of Hepatobiliary and Pancreatic Surgery, Department of Surgery, San Gerardo Hospital, University of Milan-Bicocca, Via Donizetti 106, 20052 Monza, Italy
| | - Luca Degrate
- Unit of Hepatobiliary and Pancreatic Surgery, Department of Surgery, San Gerardo Hospital, University of Milan-Bicocca, Via Donizetti 106, 20052 Monza, Italy
| | - Luca Nespoli
- Unit of Hepatobiliary and Pancreatic Surgery, Department of Surgery, San Gerardo Hospital, University of Milan-Bicocca, Via Donizetti 106, 20052 Monza, Italy
| | - Luca Gianotti
- Unit of Hepatobiliary and Pancreatic Surgery, Department of Surgery, San Gerardo Hospital, University of Milan-Bicocca, Via Donizetti 106, 20052 Monza, Italy
| | - Angelo Nespoli
- Unit of Hepatobiliary and Pancreatic Surgery, Department of Surgery, San Gerardo Hospital, University of Milan-Bicocca, Via Donizetti 106, 20052 Monza, Italy
| | - Franco Uggeri
- Unit of Hepatobiliary and Pancreatic Surgery, Department of Surgery, San Gerardo Hospital, University of Milan-Bicocca, Via Donizetti 106, 20052 Monza, Italy
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Taibbi A, Furlan A, Sandonato L, Bova V, Galia M, Marin D, Cabibbo G, Soresi M, Bartolotta TV, Midiri M, Lagalla R, Brancatelli G. Imaging findings of liver resection using a bipolar radiofrequency electrosurgical device--initial observations. Eur J Radiol 2012; 81:663-670. [PMID: 21306849 DOI: 10.1016/j.ejrad.2011.01.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 01/05/2011] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To assess contrast-enhanced US (CEUS), computed tomography (CT) and magnetic resonance (MR) imaging findings and serial changes of the treated area at follow-up in patients who underwent liver resection using a bipolar radiofrequency electrosurgical device. METHODS Imaging findings of 27 patients with resected hepatocellular carcinomas (HCCs) (n=24) and metastases (n=3) (mean size: 2.6cm), were retrospectively evaluated. Two readers assessed: the (a) presence, (b) thickness, (c) shape and (d) echogenicity (CEUS)/attenuation (CT)/signal intensity (MR imaging) at coagulated site and the (e) presence of residual tumor of the bipolar radiofrequency electrosurgical device resection margin. RESULTS Follow-up was performed with either CT (n=20) or MR imaging (n=7) and repeated in 16 patients with CT (n=7), MR imaging (n=4), or both techniques (n=5). Four patients also had a single CEUS examination. At first imaging follow-up a peripheral halo was depicted at resection site (100%). A fluid collection within the surgical area was found in 67% of patients. During the following imaging examinations a progressive involution of both findings was observed, respectively, in 81% and 62% of patients. Viable tissue was detected in three patients (11%). CONCLUSIONS After liver resection with bipolar radiofrequency electrosurgical device successfully ablated tumor is demonstrated at imaging by an unenhancing partial linear peripheral halo, in most cases, surrounding a fluid collection reducing in size during follow-up.
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Affiliation(s)
- Adele Taibbi
- Department of Radiology, University of Palermo, Palermo, 90127, Italy.
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Daylami R, Kargozaran H, Khatri VP. Liver resection using bipolar InLine multichannel radiofrequency device: impact on intra- and peri-operative outcomes. Eur J Surg Oncol 2012; 38:531-6. [PMID: 22459903 DOI: 10.1016/j.ejso.2012.02.181] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 02/11/2012] [Accepted: 02/27/2012] [Indexed: 12/17/2022] Open
Abstract
AIMS Liver resection is indicated for several primary and secondary liver lesions. We follow up our earlier experience with the use of InLine Multichannel Radiofrequency Device (ILMRD, Resect Medical Inc., Fremont, CA) a device that produces coagulative necrosis along the transection plane. METHODS The records of 68 consecutive patients who underwent liver resection for primary and metastatic liver tumors from August 2000 to December 2008 were reviewed. Data analyzed include demographic data as well as complexity of liver resection, intra-operative blood loss, use of portal triad clamping and transfusion of blood. Postoperative outcomes measured were morbidity, hospital and ICU length of stay. RESULTS The median estimated blood loss was 150 mL in the ILMRD group compared to 400 mL in the non-ILMRD group (p < 0.0001). Median length of stay was decreased in the ILMRD group by a day (7 vs. 8 p < 0.003). There was a significant decrease in frequency of parenchymal clamp time (57% vs 84%, p < 0.001) and median total portal triad clamp time (2.5 vs 30 min p < 0.0001). We also noted a significant decrease in the median portal triad clamp time (0 vs 25 min, p < 0.001) used during the parenchymal transection phase. Furthermore, use of the ILMRD device allowed us to perform more complex hepatic resections. CONCLUSION Use of ILMRD to perform radiofrequency-assisted hepatic resection was associated with a significant decrease in intra-operative blood loss and earlier discharge from the hospital despite increasing complexity of resections and decreased use of portal triad clamping.
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Affiliation(s)
- R Daylami
- Department of Surgery, University of California Davis, Davis, 4501 X Street, Suite OP 512 Pavilion, Sacramento, CA 95817, USA
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Radiofrequency assisted liver resection: analysis of 604 consecutive cases. Eur J Surg Oncol 2011; 38:274-80. [PMID: 22209064 DOI: 10.1016/j.ejso.2011.12.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 11/26/2011] [Accepted: 12/12/2011] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Intraoperative blood loss is an important factor contributing to morbidity and mortality in liver surgery. To address this we developed a bipolar radiofrequency (RF) device, the Habib 4X, used specifically for hepatic parenchymal transection. The aim of this study was to prospectively assess the peri-operative data using this technique. METHODS Between 2001 and 2010, 604 consecutive patients underwent liver resections with the RF assisted technique. Clinico-pathological and outcome data were collected and analysed. RESULTS There were 206 major and 398 minor hepatectomies. Median intraoperative blood loss was 155 (range 0-4300)ml, with a 12.6% rate of transfusion. There were 142 patients (23.5%) with postoperative complications; none had bleeding from the resection margin. Only one patient developed liver failure and the mortality rate was 1.8%. CONCLUSIONS RF assisted liver resection allows major and minor hepatectomies to be performed with minimal blood loss, low blood transfusion requirements, and reduced mortality and morbidity rates.
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Resende V, Rezende-Neto JBD, Fernandes JS, Cunha-Melo JRD. Avaliação da morbidade e da mortalidade após ressecções hepáticas. Rev Col Bras Cir 2011. [DOI: 10.1590/s0100-69912011000500007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Descrever a, morbidade e a mortalidade em pacientes submetidos à hepatectomia. MÉTODOS: Avaliou-se o tipo de hepatectomia, necessidade de transfusão sanguínea peroperatória, permanência hospitalar, complicações e a mortalidade pós-operatórias. Para análise estatística utilizou-se o teste exato de Ficher, considerando-se significativos valores de p < 0,05. RESULTADOS: Foram realizadas 22 (31,43%) hepatectomias maiores, 13 (18,57%) hepatectomias direitas com uma alargada aos segmentos IVa e IVb; nove (12,86%) hepatectomias esquerdas, dentre estas, seis incluíram o segmento I. Foram feitas 48 (68,57%) hepatectomias menores, sendo 36 (51,43%) ressecções segmentares e 12 (17,14%) ressecções não anatômicas. A principal indicação para ressecção de metástases foi o adenocarcinoma colorretal em 27 (38,57%) pacientes. O tumor primário de maior incidência foi o carcinoma hepatocelular em 14 (20%) pacientes, seguido pelo colangiocarcinoma em seis (8,57%) pacientes. Entre as 13 (18,57%) ressecções para doenças benignas predominou a litíase intra-hepática (n=6). Seis pacientes (8,57%) foram hemotransfundidos no peroperatório. A permanência hospitalar variou de 2 a 28 dias (média = quatro dias). Oito (11,43%) pacientes desenvolveram complicações pós-operatórias. A mortalidade geral foi 8,57%, concentrando-se nos pacientes com carcinoma hepatocelular (5,71%). CONCLUSÃO: As metástases de adenocarcinoma colorretal foram as principais indicações cirúrgicas e as hepatectomias menores foram os procedimentos mais realizados. Apesar da baixa incidência geral de complicações pós-operatórias, evidenciou-se alta morbimortalidade em pacientes cirróticos com carcinoma hepatocelular.
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Alemi F, Kwon E, Chiu J, Aoki H, Stewart L, Corvera CU. Laparoscopic treatment of liver tumours using a two-needle probe bipolar radiofrequency ablation device. HPB (Oxford) 2011; 13:656-64. [PMID: 21843267 PMCID: PMC3183451 DOI: 10.1111/j.1477-2574.2011.00347.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Many hepatobiliary centres are increasingly utilizing thermocoagulative devices such as bipolar-radiofrequency ablation (B-RFA). Compared with monopolar-radiofrequency ablation (M-RFA), B-RFA does not require grounding pads, thereby avoiding dermal burn injuries, and does not position probes directly into the tumour but rather on the perimeter. Additionally, B-RFA can precoagulate parenchyma to assist in hepatic resection. Herein, we report our early experience using B-RFA. METHODS A retrospective review identified 68 patients who underwent M-RFA or B-RFA between June 2004 and September 2010 in an academic centre. Peri-operative metrics were analysed. RESULTS M-RFA was used to treat 30 patients, whereas B-RFA was used for 17 patients. There were no differences in peri-operative metrics, survival or disease recurrence between M-RFA and B-RFA. Seventeen additional patients underwent B-RFA precoagulation during laparoscopic resection (segmentectomy in eleven patients and multi-segmental resection in six patients). Four patients with multifocal disease underwent procedures that combined B-RFA with resection. CONCLUSIONS The early experience utilizing B-RFA demonstrates equivalency to M-RFA with respect to peri-operative metrics and survival. Moreover, B-RFA can be utilized to precoagulate tissue during a planned resection, making it not only a useful tool for tumour therapy but also a useful adjunct during surgical resections.
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Affiliation(s)
- Farzad Alemi
- Department of Surgery, University of California, and San Francisco VA Medical Center, San Francisco, CA 94121, USA
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Multicenter experience with nonischemic multiport laparoscopic and laparoendoscopic single-site partial nephrectomy utilizing bipolar radiofrequency ablation coagulator. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2011; 2011:636537. [PMID: 21747654 PMCID: PMC3130964 DOI: 10.1155/2011/636537] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Accepted: 04/14/2011] [Indexed: 02/06/2023]
Abstract
Objective. To investigate feasibility of multiport and laparoendoscopic single-site (LESS) nonischemic laparoscopic partial nephrectomy (NI-LPN) utilizing bipolar radiofrequency coagulator. Methods. Multicenter retrospective review of 60 patients (46 multiport/14 LESS) undergoing NI-LPN between 4/2006 and 9/2009. Multiport and LESS NI-LPN utilized Habib 4X bipolar radiofrequency coagulator to form a hemostatic zone followed by nonischemic tumor excision and renorrhaphy. Demographics, tumor/perioperative characteristics, and outcomes were analyzed. Results. 59/60 (98.3%) successfully underwent NI-LPN. Mean tumor size was 2.35 cm. Mean operative time was 160.0 minutes. Mean estimated blood loss was 131.4 mL. Preoperative/postoperative creatinine (mg/dL) was 1.02/1.07 (P = .471). All had negative margins. 12 (20%) patients developed complications. 3 (5%) developed urine leaks. No differences between multiport and LESS-PN were noted as regards demographics, tumor size, outcomes, and complications. Conclusion. Initial experience demonstrates that nonischemic multiport and LESS-PN is safe and efficacious, with excellent short-term preservation of renal function. Long-term data are needed to confirm oncological efficacy.
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Martínez-Serrano MÁ, Grande L, Burdío F, Berjano E, Poves I, Quesada R. [Sutureless hepatic transection using a new radiofrequency assisted device. Theoretical model, experimental study and clinic trial]. Cir Esp 2011; 89:145-51. [PMID: 21292248 DOI: 10.1016/j.ciresp.2010.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 10/03/2010] [Accepted: 10/04/2010] [Indexed: 11/17/2022]
Abstract
The ideal instrument for performing hepatic transection should combine safe and rapid haemostasis in a single tool. We present a new multidisciplinary investigation designed to develop a hepatic transection device assisted by radiofrequency (RF); the investigation included: a computerised theoretical model, and experimental study and a clinical trial of this device. The theoretic modelling was performed by computer, based on the Finite Elements Method (FEM), with the objective of studying the distribution of electrical energy and temperature in the tissue, and to assess the effect of the characteristics of the instrument. The experimental study, based on an in vivo porcine model, suggested that the new instrument would allow the transection velocity of the hepatic parenchyma to be increased with lower bleeding per transection area compared with other techniques extensively used in liver surgery. These data should enable the first phase of clinical trial to be conducted, with preliminary results that suggest that the new device is safe and effective.
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Bong JJ, Kumar R, Spalding D. A novel technique of partial splenectomy using radiofrequency ablation. J Gastrointest Surg 2011; 15:371-2. [PMID: 20835773 DOI: 10.1007/s11605-010-1226-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 05/11/2010] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Partial splenectomy has frequently been advocated to avoid the risk of overwhelming postsplenectomy sepsis. Concerns over adequate haemostasis during partial splenectomy, however, have limited its widespread use. We have previously reported our experience of using radiofrequency (RF) ablation to minimise blood loss during hepatic and splenic resections. METHODS In this video, we illustrate the technique of partial splenectomy assisted by RF energy to minimise blood loss.
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Affiliation(s)
- Jan Jin Bong
- Department of Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS, UK.
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Chen CY, Zuchini R, Tsai HW, Huang CH, Huang SC, Lee GB, Lin XZ. Electromagnetic thermal surgery system for liver resection: An animal study. Int J Hyperthermia 2010; 26:604-9. [DOI: 10.3109/02656736.2010.495105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Nanashima A, Tobinaga S, Abo T, Nonaka T, Sawai T, Nagayasu T. Usefulness of the combination procedure of crash clamping and vessel sealing for hepatic resection. J Surg Oncol 2010; 102:179-83. [PMID: 20648591 DOI: 10.1002/jso.21575] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Minimization of blood loss during resection of the hepatic parenchyma in hepatectomy remains a major problem. The usefulness of the LigaSure sealing system has been reported. OBJECTIVES To evaluate the efficacy of combination procedure of LigaSure and forceps clamping for control blood loss and transection time in hepatectomy. METHODS Here, we report our experience with the combination technique of LigaSure Precise, a clamp forceps type, and crush clamping method for hepatic transection in 33 patients who underwent hepatectomy. RESULTS The combination technique allows fast and bloodless transection even along the major intrahepatic vessels. Blood loss and transection time were significantly reduced in the group of LigaSure use (P < 0.05). Efficient hemostasis could be achieved also in patients with extensive liver injury such as cirrhosis. The rates of postoperative intraabdominal abscess formation in the combination technique of LigaSure and crush clamping were lower compared with the conventional crush clamping method (P < 0.05). CONCLUSIONS The combined use of LigaSure Precise and crush clamping technique is safe and allows rapid completion of hepatic resection.
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Affiliation(s)
- Atsushi Nanashima
- Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
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Shan YS, Zuchini R, Tsai HW, Lin PW, Lee GB, Lin XZ. Bloodless Liver Resection Using Needle Arrays Under Alternating Electromagnetic Fields. Surg Innov 2010; 17:95-100. [DOI: 10.1177/1553350610368406] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background/Aim: Hemostasis is a major difficulty associated with hepatectomies. The authors designed a new thermal surgery system to reduce blood loss. Methods: The newly designed system consists of an alternating magnetic field generator and stainless steel needle arrays with thermosensitive bands. Lanyu pigs were used: 4 for the Kelly crushing method and 4 for the newly designed method. The procedures used were S4-S5 segmentectomies or left lateral segmentectomies, after which the amount of blood loss and operation times were compared. The pigs were observed for 4 weeks, after which liver pathologies were studied. Results: The blood loss in the method proposed by the authors was almost 0 mL, whereas with the Kelly crushing method it was 116 ± 35 mL. The method proposed in this study can save 15 to 25 minutes of operation time. The resected liver margins exhibited prominent apoptosis and fibrotic change in the remnant livers. Conclusions: The method proposed is a novel new way of performing thermal surgery.
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Affiliation(s)
| | | | | | - Pin-Wen Lin
- National Cheng Kung University, Tainan, Taiwan
| | - Gwo-Bin Lee
- National Cheng Kung University, Tainan, Taiwan
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Reuter NP, Martin RCG. Microwave energy as a precoagulative device to assist in hepatic resection. Ann Surg Oncol 2010; 16:3057-63. [PMID: 19727958 DOI: 10.1245/s10434-009-0688-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2009] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Microwave energy is another energy source than can be used to precoagulate hepatic tissue during hepatic resection. The aim of this study was to develop an optimal microwave precoagulation technique in a porcine model and then validate the technique during hepatic resection in patients. METHODS Institutional Animal Care and Use and Institutional Review Board (IRB)-approved protocols were utilized for hepatic resection in a porcine model and validation in patients using microwave energy for precoagulation. Different numbers of antennas (one, two or three; spaced 5 mm apart) and ablation times (20, 30, 40, and 60 s) were evaluated to identify an optimal technique that effectively provided precoagulation. RESULTS Animal studies: Two antennas for 30 s provided the optimal ablation time, ablation width, mean size of largest vessel coagulated, and minimal bleeding when compared with other techniques. However, given that this is not an optimal technique for laparoscopic precoagulation, one antenna for 60 s was found to provide similar precoagulation success. Patient validation: To validate these techniques, three patients underwent open hepatectomy using two antennas with 5 mm spacing for 30 s, demonstrating successful precoagulation up to inflow/outflow vessels of 10 mm size or greater, which were controlled with a vascular stapler. In addition three patients underwent laparoscopic hepatectomy using one antenna for 60 s and demonstrated successful precoagulation up to inflow/outflow vessels of 8 mm or greater, which were controlled with a vascular stapler. CONCLUSION Microwave energy is a safe and effective precoagulation device to achieve good hemostasis during hepatic resection with both open and laparoscopic technique.
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Affiliation(s)
- Nathan P Reuter
- Division of Surgical Oncology, Department of Surgery, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY, USA
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