Abstract
Background: Computer-assisted navigation during thermal ablation of liver tumours, may help to correct needle placement and improve ablation efficacy in percutaneous, laparoscopic and open interventions. The potential advantage of using high frequency jet-ventilation technique (HFJV) during the procedure is by minimising the amplitude of respiration-related upper-abdominal organs movements. The aim of this clinical methodological trial was to establish whether HFJV would give less ventilatory induced liver movements than conventional ventilation, during stereotactic navigated ablation of liver metastases under open surgery. Methods: Five consecutive patients scheduled for elective, open liver ablation under general propofol and remifentanil anaesthesia were included in the study protocol. During the stereotactic targeting of the tumours, HFJV was chosen for intraoperative lung ventilation. For tracking of liver movement, a rigid marker shield was placed on the liver surface and tracked with an optical position measurement system. A 4D position of the marker shield was measured for HFJV and conventional tidal volume lung ventilation (TV). At each time point the magnitude of liver displacement was calculated as an Euclidean distance between translational component of the marker shield's 3D position and previously estimated centroid of the translational motion. Results: The mean Euclidean liver displacement was 0.80 (0.10) mm for HFJV and 2,90 (1.03) mm for TV with maximum displacement going as far as 12 mm on standard ventilation (p=0.0001). Conclusion: HFJV is a valuable lung ventilation method for patients undergoing stereotactic surgical procedures in general anaesthesia when reduction of organ displacement is crucial.
Highlights
Thermal ablation of primary and secondary liver tumours is a potentially curative treatment, and an alternative for patients not eligible for surgical resection due to severe comorbidity or underlying liver disease
Anaesthesia management protocol General anaesthesia was induced and maintained by total intravenous technique (TIVA) with target controlled infusion (TCI Alaris, PK CareFusion, Sarl, Switzerland) of propofol 2–6μg/ml according to Marsh pharmacokinetic model (Propofol Sandoz®, Sandoz, Copenhagen, Denmark) and remifentanil 2-10ng/ml according to Minto pharmacokinetic model (Ultiva®, GlaxoSmithKline,Solna, Sweden) with muscle relaxation achieved by rocuronium 0,6 mg/kg during induction of anaesthesia, followed by incremental doses of 0,15mg/kg during surgery (Rocuronium, Fresenius Kabi, Uppsala, Sweden)
In certain clinical situations, such as in stereotactic ablative procedures, it can be difficult to establish since there is a demand for keeping respiratory organ displacement to a minimum
Summary
Thermal ablation of primary and secondary liver tumours is a potentially curative treatment, and an alternative for patients not eligible for surgical resection due to severe comorbidity or underlying liver disease. Computer-assisted navigation during thermal ablation of liver tumours, may help to correct needle placement and improve ablation efficacy in percutaneous, laparoscopic and open interventions. The potential advantage of using high frequency jetventilation technique (HFJV) during the procedure is by minimising the amplitude of respiration-related upper-abdominal organs movements. The aim of this clinical methodological trial was to establish whether HFJV would give less ventilatory induced liver movements than conventional ventilation, during stereotactic navigated ablation of liver metastases under open surgery. Conclusion: HFJV is a valuable lung ventilation method for patients undergoing stereotactic surgical procedures in general anaesthesia when reduction of organ displacement is crucial
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call