Hand-assisted laparoscopic microwave coagulation therapy for hepatocellular carcinoma

Abstract

Microwave coagulation therapy has been used for local ablation of hepatocellular carcinoma in the setting of liver cirrhosis. This technique can be performed laparoscopically when the tumor is located on the surface of the liver or attached to other intraabdominal organs. However, a laparoscopic approach becomes difficult when it is necessary to mobilize the liver or lyse adhesions to gain access to the tumor. We used a hand-assisted laparoscopic technique for the applicafion of microwave coagulation therapy in two cirrhotic patients with hepatocellular carcinoma to ensure safe mobilization of the liver and adhesiolysis. The first patient presented with a 4.5-cm mass in the left lobe of the liver that was densely adherent to the lesser omentum. The use of a hand-assist device allowed us to perform a safe exptoration, adhesiolysis, and subsequent tumor ablation. In the second patient, the tumor was located on the posterior aspect of the right lobe of the liver. The handassist device allowed safe mobilization of the liver and exposure of the tumor. No significant postoperative complications were noted in either patient. Complete ablation of the tumors was confirmed with contrastenhanced computed tomography scanning. In conclusion, hand-assisted iaparoscopy is an effective adjunct to microwave ablation therapy in patients with hepatocellular carcinoma and liver cirrhosis. It enables the safe completion of the procedure under laparoscopic guidance, thereby averting laparotomy.