Laparoscopic Radiofrequency Research Articles

Detection of telomerase activity in biopsy samples for predicting prognosis in cirrhotic patients with hepatocellular carcinoma after laparoscopic radiofrequency ablation therapy

To explore the role of telomerase activity detected in biopsy samples for evaluating the efficacy of laparoscopic radiofrequency ablation (RFA) therapy in patients with hepatocellular carcinoma (HCC) and liver cirrhosis. From August 2001 to October 2004, 34 cirrhotic patients with HCC were treated by laparoscopic RFA under general anesthesia. A total of 34 tumors, with a mean maximum tumor diameter of 4.0 ± 1.0 cm, were all located on the liver surface or adjacent to the gallbladder. Laparoscopic ultrasound-guided core biopsy for liver lesions was performed before and immediately after RFA therapy. In these biopsy samples, telomerase activity was detected by the ELISA-based telomeric repeat amplification protocol (ELISA-TRAP) assay, and pathological examination was routinely performed. Laparoscopic RFA was successfully performed in all the 34 patients. A complete tumor necrosis was achieved in all patients on the contrast-enhanced helical CT scanning one month after laparoscopic RFA. The positive rates of telomerase activity and histopathologic diagnosis in biopsy samples were 91.2% (31/34) and 100% (34/34) respectively before RFA, and 26.5% (9/34) and 0% respectively after RFA. During a median follow-up period of 35 months (range, 18–51 months), the rates of local tumor recurrence at the ablation sites in post-RFA telomerase-positive and negative patients were 88.9% (8/9) and 4% (1/25) respectively (P 0.05). For cirrhotic patients with HCC treated by laparoscopic RFA, detection of telomerase activity in biopsy samples may be useful for evaluating the therapeutic efficacy of RFA and predicting postoperative local tumor recurrence.

Evaluation of an online navigation system for laparoscopic interventions in a perfused ex vivo artificial tumor model of the liver

Background. Laparoscopic radiofrequency ablation (RFA) is a safe and effective method for tumor destruction in patients with unresectable liver tumors. However, accurate probe placement using laparoscopic ultrasound guidance is required to achieve complete tumor ablation. After evaluation of an ultrasound navigation system for transcutaneous and open RFA, we now intend to tranfer this technique to laparoscopic liver surgery. This study aimed to evaluate an electromagnetic navigation system for laparoscopic interventions using a perfusable ex vivo artificial tumor model. Materials and methods. First a special adapter was developed to attach the ultrasound and electromagnetic tracking-based navigation system to a laparoscopic ultrasound probe. The laparoscopic online navigation system was studied in a laparoscopic artificial tumor model using perfused porcine livers. Artificial tumors were created by injection of a mixture of 3% agarose, 3% cellulose, and 7% glycerol, creating hyperechoic lesions in ultrasound. Results. This study showed that laparoscopic ultrasound-guided navigation is technically feasible. Even in cases of angulation of the ultrasound probe no disturbances of the navigation system could be detected. Artificial tumors were clearly visible on laparoscopic ultrasound and not felt during placement of the RFA probe. Anatomic landmarks and simulated ‘tumors’ in the liver could be reached safely. Discussion. Laparoscopic RFA requires advanced laparoscopic ultrasound skills for accurate placement of the RFA probe. The use of an ultrasound-based, laparoscopic online navigation system offers the possibility of out-of-plane needle placement and could increase the safety and accuracy of punctures. The perfused artificial tumor model presented a realistic model for the evaluation of this new technique.

MR-compatible laparoscope with a distally mounted CCD for MR image-guided surgery

Objects We have developed a new MR-compatible laparoscope that incorporates a distally mounted charge-coupled device (CCD). The MR-compatibility and feasibility of laparoscopy using the new laparoscope were evaluated during MR image-guided laparoscopic radiofrequency ablation therapy (RFA).

Morbidity and mortality of laparoscopic vs. open radiofrequency ablation for hepatic malignancies

Aims Surgical radiofrequency ablation (RFA) of hepatic malignancies is associated with superior oncological outcome as compared to percutaneous RFA. The aim of this prospective non-randomized cohort study was to compare morbidity and mortality of laparoscopic (LRFA) vs. open (ORFA) radiofrequency ablation of liver cancer. Methods Between October 1999 and November 2006, RFA was performed in 154 consecutive patients (percutaneous 12, LRFA 93, ORFA 49) for a total of 291 hepatic tumours (HCC 81, colorectal metastases 157, other 53). Seventy-four patients simultaneously underwent additional surgery. Laparoscopic RFA was performed in 45/54 patients with HCC, and in 44/54 patients with cirrhosis. Laparotomy was performed in 14/22 patients who underwent simultaneous colorectal resection, and in 12/22 patients with hepatic resection. Results Postoperative complications occurred in 25 patients with subsequent mortality in 2. As compared with LRFA, ORFA was associated with significantly ( p < 0.01) higher intra-operative blood loss (median 20 (range 0–1700) vs. 10 (0–900) ml), longer duration of surgery (180 (25–440) vs. 75 (30–390) min), more postoperative complications (17 vs. 8), and longer postoperative hospital stay (8 (1–127) vs. 4 (1–51) d). According to the therapy-oriented severity grading system (TOSGS) classification, postoperative complications in the ORFA-group were more severe than those in the LRFA-group ( p < 0.01). These findings were consistent in patients without simultaneous colorectal and/or hepatic resection and in patients with liver tumours measuring 3 cm or less. In univariate analysis the following factors were significantly ( p < 0.01) related to the presence of postoperative complications: simultaneous colorectal resection, laparotomy, duration of surgery, tumour location in right liver, liver segment 7 ( p = 0.01), absence of cirrhosis ( p = 0.02), liver segment 8 ( p = 0.03), and metastatic liver cancer ( p = 0.04). Conclusion LRFA for hepatic malignancies seems preferable above ORFA, provided good patient selection, surgical expertise, and long-term oncological control.

Indications for Hand-Assisted Laparoscopic Radiofrequency Ablation for Liver Tumors

Radiofrequency ablation has established itself as the preferred treatment for irresectable liver tumors. It can be performed either percutaneously, laparoscopically, or by open surgery. The choice of approach depends on the patient and tumor-related variables. The laparoscopic approach appears to be the safest and most effective method for small tumors on the liver surface. It also provides additional information on the intrahepatic tumor burden with the use of intraoperative ultrasound and staging laparoscopy. Furthermore, the pneumoperitoneum reduces the flow of the portal vein and increases the efficacy of the ablation. Depending on the location of the tumor, mobilization of the liver or lysis of adhesions from previous surgery can require open surgery. Our aim was to study the combined use of laparoscopy and laparotomy by using hand-assisted laparoscopic radiofrequency ablation. We performed hand-assisted laparoscopy to ablate nine tumors in seven patients, enabling us to combine most of the advantages of laparoscopy and open surgery. The radiofrequency ablation was technically simple to perform. A laparoscopy of the entire abdominal cavity and a thorough examination of the entire liver via ultrasound was also performed. The electrode was accurately placed in all patients. In four patients, a complete mobilization of the right lobe was performed to obtain the easiest possible access to the tumor. In three patients, severe adhesions from previous surgeries were removed prior to insertion of the laparoscopic tools. The ablation was completed safely and successfully in all patients. Our overall impression of the hand-assisted laparoscopic approach is that it seems to have a major advantage in comparison with simple laparoscopy, specifically for adhesions from previous surgeries and when the right liver lobe requires mobilization. Also, needle placement seems to be far more accurate than with simple laparoscopy.

Development of a perfused ex vivo tumor-mimic model for the training of laparoscopic radiofrequency ablation

Laparoscopic radiofrequency ablation (RFA) is a safe and effective method for tumor destruction in patients with unresectable liver tumors. However, accurate probe placement using laparoscopic ultrasound guidance is required to achieve complete tumor ablation. This study aimed to develop a perfusable ex vivo tumor-mimic model for laparoscopic radiofrequency ablation training. After rinsing the prepared liver vessels with anticoagulants, porcine livers were perfused. Tumor-mimics were created by injecting a mixture consisting of 3% agarose, 3% cellulose, 7% glycerol, and 0.05% methylene blue, creating hyperechoic lesions in ultrasound. Heparinized porcine blood was used as perfusion medium. Continuous perfusion of the porcine liver was provided by connection of a pump system to the portal vein and the vena cava inferior. Laparoscopic RFA techniques were taught using a laparoscopic pelvi-trainer. A total of 30 laparoscopic ablations were performed in four porcine livers. The simulated "tumors" were clearly visible on laparoscopic ultrasound and not felt during placement of the RFA probe. In addition, color duplex ultrasound showed clear signals indicating for a sufficient liver perfusion. Laparoscopic RFA requires advanced laparoscopic ultrasound skills for an accurate placement of the RFA probe. The perfused tumor-mimic model presented is a safe, easy, effective, and economic method to improve and train laparoscopic RFA skills on porcine liver tissue.

Perioperative outcome after laparoscopic radiofrequency ablation of liver tumors: an analysis of 521 cases

Radiofrequency thermal ablation (RFA) is gaining increased acceptance for the treatment of unresectable primary and metastatic liver tumors. Understanding the morbidity and laboratory changes after RFA is important for operative indications and perioperative management. The authors prospectively analyzed the 30-day morbidity and mortality rates of patients undergoing laparoscopic RFA for liver tumors in a 10-year period. Laboratory studies included a complete blood count, electrolytes, liver function tests, prothrombin time/international normalized ratio (INR), and tumor markers obtained preoperatively, on postoperative days (PODs) 1 and 7, then at 3 months. A total of 521 RFA procedures were performed for 428 patients (286 men and 142 women) with a mean age of 61 years (range, 25-89 years). A total of 346 patients underwent a single operation, and 82 patients had two or more operations. The pathology was metastatic colon cancer for 244 patients (47%), hepatocellular cancer for 109 patients (21%), metastatic neuroendocrine cancer for 74 patients (14%), and other noncolorectal, nonneuroendocrine liver metastasis for 94 patients (18%). A total of 1,636 lesions (mean, 3.1 per patient; range, 1-16) were ablated. The mean tumor size was 2.7 +/- 1.6 cm (range, 0.3-11.5 cm). All cases were managed laparoscopically. The 30-day mortality rate was 0.4% (n = 2), and the morbidity rate was 3.8 % (n = 20). The average length of hospital stay was 1 day for RFA-only cases and 2.1 days when another surgical procedure was combined with RFA. Serum aspartate aminotransferase (AST) increased 14-fold, alanine aminotransferase (ALT) increased 10-fold, and bilirubin levels increased 2-fold on POD 1, with return to baseline in 3 months. Serum alkaline phosphatase and gamma-glutamyltransferase (GGT) levels showed a 25% increase on POD 7, with return to baseline in 3 months. There were no significant changes in platelet counts or prothrombin times postoperatively. This large series provides valuable insight into the perioperative period and allows the expected morbidity of the procedure to be understood. Despite significant patient comorbidities, this procedure was tolerated with low morbidity and mortality rates. Postoperative coagulopathy was not observed. A postoperative rise in liver function tests is expected, reflecting the liver injury response to RFA. This information can be used to expand the patient population that may benefit from laparoscopic RFA.

Technical Aspects And Feasibility of Laparoscopic Ultrasound Navigation in Radiofrequency Ablation of Unresectable Hepatic Malignancies

Laparoscopic radiofrequency ablation is safe, practicable, and combines minimally invasive surgery with the advantages of laparotomy. However, application of the laparoscopic freehand puncture is restricted because of capnoperitoneum and the consequent fixation of the needle on two different points. The use of a laparoscopic ultrasound probe with a canal for puncture can solve this problem and improve precision. However, a stiff needle limits the necessary angulation that is needed to reach right-lateral and cranial liver metastases. Therefore we present a new navigation tool for laparoscopic interventions. The US Guide 2000 (Ultra Guide, Tirat Hacarmel, Israel) is an independent navigation system compatible with all ultrasound machines and has six degrees of freedom. After proper evaluation of this system under operating room conditions during transcutaneous radiofrequency ablation, we used this technique in laparoscopic radiofrequency ablation. A special adapter was developed to attach the ultrasound-based navigation system to a laparoscopic ultrasound probe. After calibrating the system with an ultrasound phantom, laparoscopic navigation in a liver organ model was studied. Even in cases of angulation of the ultrasound probe no disturbances of the navigation system could be detected. Anatomic landmarks in the liver could be safely reached. No interaction between the navigation system and the laparoscopic ultrasound probe or operating instruments was observed. Our preliminary results show the feasibility of this technique in laparoscopic radiofrequency ablation. The use of an ultrasound-based laparoscopic inline navigation system offers the possibility of out-of-plane needle placement and could combine the flexibility of freehand puncture with the accuracy of a canal for puncture. This could increase the safety and accuracy of punctures.

183: Laparoscopic surface scanning and subsurface targeting: Implications for image-guided laparoscopic liver surgery

Background: Practical image-guided surgical (IGS) techniques are needed for laparoscopic liver surgery to gain greater clinical utility. Both laparoscopic radiofrequency ablation and liver resection are dependent upon accurate intraoperative tumor localization to ensure hemostasis as well as acceptable oncologic results. Because of the liver’s limited external landmarks and complex internal anatomy, such tumor localization poses a technical challenge. IGS addresses this problem by mapping the real-time, intraoperative position of surgical instruments onto preoperative tomographic imaging through a process called registration.

Skin Burn after Laparoscopic Radiofrequency Thermal Ablation for Uterine Myoma - A case report -

Laparoscopic radiofrequency thermal ablation is a promising new approach for the conservative treatment of a uterine myoma. I report a pad burn in a patient undergoing laparoscopic radiofrequency thermal ablation for a uterine myoma. The burn occurred at the leading edge of the pad attached to the patient`s thigh. The burn was treated successfully with dressings. (Korean J Anesthesiol 2007; 52: 224~7)

Progression of renal tumors after laparoscopic radiofrequency ablation

Objectives To describe 2 patients with tumor progression after treatment with radiofrequency ablation (RFA). RFA is a minimally invasive, Food and Drug Administration-approved technique used to treat solid organ tumors. However, few studies of RFA treatment failure have been reported. Methods As a part of an institutional review board-approved protocol, nine renal tumors were ablated with RFA during a 2-year period. Patients enrolled on the protocol were assigned to one of two arms—ablate and resect and ablate and follow-up—depending on the patient’s health, tumor characteristics, and tumor location and size. The average tumor size was 4.5 cm in the largest dimension, and the tumors were accessed percutaneously using computed tomography or ultrasound guidance, with direct laparoscopic visualization or through an open incision for concomitant nephrectomy. Postoperative follow-up examinations occurred at 3-month intervals for 2 years using serial computed tomography or magnetic resonance imaging. Results Two patients (22%) in the ablate and follow-up arm of the study experienced significant tumor progression less than 1 year after RFA. One tumor increased in size by 20% and the other quadrupled in size and developed a renocolic fistula. This is the first reported case of a renocolic fistula after RFA of a renal tumor. Both patients subsequently underwent radical nephrectomy with the final pathologic results showing renal cell carcinoma. Conclusions Rapid tumor progression and renocolic fistula formation are possible complications of RFA. This treatment requires close and aggressive follow-up to ensure complete eradication of the renal lesion.

Comparison of laparoscopic radiofrequency ablation with surgical resection for treatment of giant hepatic cavernous hemangioma

目的 比较分析腹腔镜射频消融(RFA)与外科切除治疗巨大肝脏海绵状血管瘤(HCH)的疗效、并发症及各临床参数.方法 2001年3月至2005年2月,31例病人共39个HCH病灶在全麻下进行了腹腔镜RFA治疗或外科切除术.男7例,女24例,平均年龄(47.7±8.6)岁.病人均表现为上腹部不适、疼痛或腹胀等症状.术前经超声、螺旋CT及MRI检查获得确诊,平均最大肿瘤直径(9.6±1.4)cm.结果 17例HCH成功实施了腹腔镜RFA治疗,14例进行了外科切除术.腹腔镜RFA组及外科切除组的平均出血量分别为(192.4±85.0)ml及(714.3±276.3)ml(P＜0.01),平均手术时间为(107.5±34.4)min及(115.4±23.7)min(P＞0.05),平均术后住院日为(4.9±1.2)d及(11.6±3.0)d(P＜0.01).腹腔镜RFA组均未输血,外科切除组中10例输血.腹腔镜治疗组中,2例出现一过性血红蛋白尿;外科切除组中,1例出现术后腹腔渗血,另1例肺部感染.所有病例术后均出现血清转氨酶(ALT及AST)一过性升高.随访6～35个月(中位21个月),腹腔镜RFA治疗组病灶完全坏死率达100%,外科切除组均未见残留病灶.腹腔镜RFA治疗组中,15例症状完全消失,2例症状明显改善;外科切除组中,13例无症状,1例右上腹轻度不适.结论 外科切除仍然是巨大HCH最有效的治疗方法.腹腔镜RFA治疗巨大HCH具有微创、避免输血、缩短住院日等优点,治疗效果肯定,适用于病灶位于肝脏表面或临近胆囊等空腔脏器的病人,术中超声的应用可有效避免相关并发症的发生。

A prototype ultrasound-guided laparoscopic radiofrequency ablation system

Advanced laparoscopic procedures, particularly laparoscopic liver resection and ablation, may benefit from image-guided surgery techniques that involve interactive three-dimensional imaging and instrument tracking. A prototype system for laparoscopic ultrasound-guided radiofrequency ablation was designed and implemented. This system uses an infrared camera to track instruments and runs on a personal computer. Features of the system include spatially registered ultrasound visualization, volume reconstruction, and interactive targeting. Targeting of accuracy studies was performed by directing a tracked needle to a phantom target. Ultrasound data collection and volume reconstruction can be achieved within minutes and interactively reviewed by the surgeon. Early results with phantom experiments demonstrate a targeting accuracy of 5 to 10 mm. These results support the further development of this and similar image-guided surgery systems for specific laparoscopic procedures. Eventually, rigorous clinical evaluation will be necessary to prove their value.

Peripheral temperature monitoring for laparoscopic and CT-guided radio frequency ablation of renal masses

Peripheral temperature monitoring for laparoscopic and CT-guided radio frequency ablation of renal masses

Hemoglobinuria during laparoscopic radiofrequency ablation of hepatocellular carcinoma

Hemoglobinuria during laparoscopic radiofrequency ablation of hepatocellular carcinoma

Comparative analysis of CT-scan and PET-scan with intraoperative ultrasound (IOUS) in detecting liver metastases

3632 Background: Open, laparoscopic or percutaneous radiofrequency ablation (RFA) has been used for the surgical treatment of liver metastases (mets). However, it requires accurate preoperative (preop) localization of liver mets. CT scan and PET scan have been widely used for such preop evaluation. However, intraoperative ultrasound (IOUS) remains the gold standard. Very little data is available comparing IOUS with preop CT and/or PET scan. Thus, a retrospective study was done to compare the efficacy of IOUS with preop CT and/or PET scan in detecting the number of liver mets. Methods: A retrospective chart review was done that included all patients (pts) who underwent surgical treatment for liver mets. Data was obtained from medical records, radiology, intraop reports. Results: 53 pts including 57% men and 43% women with a median age of 62years (age range 35–80 years) were included in the study. Imaging data was available for CT, PET and IOUS in 53, 24 and 39 pts respectively. CT, PET, and IOUS detected 2.4, 1.7 and 2.6 lesions/ pt respectively. In 24 patients, both CT and PET scan report was available. Of these, the imaging study detecting the maximum number of lesions was selected for comparison of preop evaluation with IOUS. A comparison between preop imaging (CT/PET scan) vs. IOUS in these 24 pts revealed an average of 2.3 vs. 2.8 lesions/pt respectively ( Table ). When compared with preop imaging (CT/PET scan), IOUS detected additional lesions in 33% pts; fewer lesions in 17% pts and similar number of lesions in 50% pts. Comparison between CT and IOUS in 39 patients revealed 1.9 vs. 2.6 lesions/pt respectively and that between PET and IOUS in 24 patients revealed 1.7 vs. 2.8 lesions/pt respectively. Conclusions: Although CT scan and PET scan remains effective modalities for preop evaluation of liver mets, IOUS is found to be superior for planning accurate surgical treatment. Thus, the efficacy of percutaneous RFA may be limited due to inability to perform IOUS. [Table: see text] No significant financial relationships to disclose.

Pattern of carcinoembryonic antigen drop after laparoscopic radiofrequency ablation of liver metastasis from colorectal carcinoma

Laparoscopic radiofrequency ablation (RFA) is being increasingly used for local control of hepatic metastasis from colorectal carcinoma (CRC). After surgical resection of colorectal liver metastasis, carcinoembryonic antigen (CEA) values fall within 2 weeks, making this a useful parameter to follow shortly after surgery. Little is known, however, about the expected pattern of the CEA drop after RFA. From September 1998 to October 2002, RFA to CRC liver metastasis was performed on 144 patients. A subset of 17 patients were studied who had no evidence of extrahepatic disease preoperatively, had all detectable tumor ablated intraoperatively, and who on long-term follow-up (up to 15 months) had no evidence of recurrent disease. Serum CEA was determined preoperatively, on the first postoperative day, at 1 week, and every 3 months afterwards. A computed tomography (CT) scan of the abdomen and pelvis was obtained every 3 months postoperatively. Ten (58.8%) patients showed an increase in CEA on postoperative Day 1, averaging 38.3% compared with the preoperative value. CEA then fell to 50% of the preoperative value, on average, on Day 7 postoperatively and only reached its nadir at 3 months. Unlike resection patients, those undergoing ablation show an initial rise in CEA, probably due to release from the ablated tissue. Although heating of RFA would be expected to destroy CEA, the initial rise and slow drop postoperatively argue for a release of immunoreactive CEA from the ablated zone. This slow decline in CEA indicates that several months should pass before assessing the extent of potential residual disease.

Laparoscopic Radiofrequency Renal Ablation in Patients with Simultaneous Visceral Tumors: Long-Term Follow-Up

To report our experience with in situ laparoscopic radiofrequency ablation (RFA) of renal tumors. From September 2000 to May 2002, two men, 81 and 71 years old, and one woman, 75 years old, were referred to our department for right renal clear-cell carcinoma <3.5-cm diameter. The 71- year-old patient had only one kidney. Because of the tumor location, the percutaneous route was not considered the approach of choice. Moreover, a simultaneous large right adrenal incidentaloma (myelolipoma) and a right colon cancer were known to be present in the second and third patient, respectively. The aforementioned findings suggested the laparoscopic route as a preferable technique to treat both the renal and the other morbidities. Under laparoscopic ultrasonography control of tine placement, a 20-minute thermoablation cycle at 100 degrees C mean temperature was performed. Including right colectomy and right adrenalectomy, the operative time was 120, 200, and 275 minutes, with postoperative hospital stays of 3, 4, and 6 days for the three patients, respectively. Abdominal CT scans after 1 and 4 weeks and then every 6 months confirmed complete treatment of the lesion at 44 months' average follow-up (range 36-56 months). When percutaneous access is not feasible or the patient should undergo another laparoscopic procedure simultaneously, laparoscopic RFA of renal tumors is feasible and effective, as shown by long-term follow-up.

1154: Laparoscopic ultrasonography for abdominal tumors

Accurate preoperative staging of gastrointestinal malignancies is of major importance in the decision for adequate stage-related therapy. There is evidence that laparoscopy in combination with laparoscopic ultrasound (L-LUS) is more accurate in the detection of intraabdominal tumors than conventional preoperative imaging. Staging L-LUS is a minimally invasive technique that reveals local tumor extent and intraabdominal disseminated tumor spread. Therefore, laparoscopic ultrasound is an ideal adjunct to laparoscopy because this technique may compensate for the lack of tactile feedback with laparoscopic instruments. The concept of using ultrasound through a laparoscopic access for liver tumors was first described by Yamakawa et al. in 1958, but it was only since the end of the 1980s that laparoscopic ultrasound probes were introduced in the clinical practice. Currently available data indicate that L-LUS provides information similar to that obtained by intraoperative ultrasound and can identify lesions that are too small to be visible by preoperative imaging techniques. Furthermore, L-LUS also allows performance of US-guided biopsy or interstitial therapies as ethanol injection, cryoablation or radiofrequency thermal ablation in the same session. Laparoscopic radiofrequency represents a safe and effective treatment for patients with hepatocellular carcinoma not amenable to surgical resection, especially when the percutaneous approach to the lesion is deemed very difficult or impossible. Better protection of vital structures and a more accurate staging are major advantages of this approach. In the future, these advantages and the possibility to perform a more aggressive approach (in association with local vascular exclusion) could favor a more extensive use of the laparoscopic radiofrequency. More recently, some series of laparoscopic segmentectomy were reported; the authors showed that laparoscopic resections are feasible and safe in selected patients with left-sided and right-peripheral lesions requiring limited resections. Staging L-LUS can also provide a significant effect in the multimodal approach to a population of patients undergoing regional treatment of hepatic colorectal metastases. Staging L-LUS also acts as a bridge to a potential laparoscopic approach of both primary colon tumor and liver metastases. Patients with hilar cholangiocarcinoma and gallbladder cancer frequently have unresectable disease that is not apparent on preoperative imaging studies. L-LUS can correctly identify unresectable disease and prevents unnecessary laparotomy in about one third of patients. Color-coded Doppler imaging can be very valuable for the assessment of resectability in patients with pancreatic cancer. Current data confirm that laparoscopic ultrasound is capable of enhancing the accuracy of staging laparoscopy. Compared to standard laparoscopy, a combination of both techniques markedly increases the sensitivity of staging laparoscopy in the determination of unresectable disease. This is of major importance in the assessment of occult liver metastases and lymph node involvement. Laparoscopic ultrasonography improves the diagnostic accuracy compared to conventional imaging techniques and should be considered as integral part of staging laparoscopy. It may help in choosing the most suitable treatment for the patient. However, a steep learning curve for L-LUS has been reported, and a training workshop experience with LUS will be needed to improve both accuracy rates and LUS technique.

1060: Cost Analysis for Four Techniques of Renal Tumor Ablation: Laparoscopic and Percutaneous Radiofrequency Ablation and Cryoablation

You have accessJournal of UrologyDiscussed Poster, Tuesday, May 23, 2006, 9:00 am - 12:00 pm1 Apr 20061060: Cost Analysis for Four Techniques of Renal Tumor Ablation: Laparoscopic and Percutaneous Radiofrequency Ablation and Cryoablation Sangtae Park, Beau N. Dusseault, Yair Lotan, John Pattaras, and Kenneth Ogan Sangtae ParkSangtae Park More articles by this author , Beau N. DusseaultBeau N. Dusseault More articles by this author , Yair LotanYair Lotan More articles by this author , John PattarasJohn Pattaras More articles by this author , and Kenneth OganKenneth Ogan More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)33285-3AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1060: Cost Analysis for Four Techniques of Renal Tumor Ablation: Laparoscopic and Percutaneous Radiofrequency Ablation and Cryoablation." The Journal of Urology, 175(4S), pp. 340–341 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 175Issue 4SApril 2006Page: 340-341 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Sangtae Park More articles by this author Beau N. Dusseault More articles by this author Yair Lotan More articles by this author John Pattaras More articles by this author Kenneth Ogan More articles by this author Expand All Advertisement Loading ...