RF-assisted Liver Resection Research Articles

Positive Immuno-Modulation Following Radiofrequency Assisted Liver Resection in Hepatocellular Carcinoma.

Introduction: Hepatocellular carcinoma (HCC) often develops on a background of chronic inflammation and a complex immunosuppressive network with increased regulatory T cells, impaired CD8+ T cells and the secretion of immunosuppressive cytokines. Previous clinical studies have reported a superior disease-free survival (DFS) following a radiofrequency-based ablation or resection in HCC tumours compared to conventional liver resection techniques. The aim of this study was to investigate whether there is any correlation with the use of a radiofrequency-assisted liver resection and clinical outcome. Material and Methods: Patients’ peripheral blood was collected prior and 7 days following surgery from patients undergoing a liver resection for HCC. There were 5 liver resections performed using CUSA and 6 liver resections with the RF-based device, HabibTM 4X. The primary endpoint of the study was to assess the immunological parameters of circulating immune cell populations as well as serum cytokines. The Student’s t-test, chi-square or Fisher’s Exact test were applied for statistical comparisons, as appropriate. Results: Patients undergoing an RF-assisted liver resection with HabibTM 4X had a significant decrease in the inhibitory Treg cells (p = 0.002) and a significant increase in CD8+ T lymphocytes (p = 0.050) and CD4+CD45RO+/CD4+ memory T cells (p = 0.002) compared to those patients undergoing a liver resection with CUSA. It was also noted that the RF-assisted liver resection group had a significant decrease in circulating TGF-ß (p = 0.000), IL10 (p = 0.000) and a significant increase in IFN-gamma (p = 0. 027) and IL-17 compared to the CUSA group. Conclusion: A liver resection with RF-based device HabibTM 4X was associated with positive immunomodulatory changes in circulating immune cells and circulating cytokines which could explain the significant improvement in DFS.

Radiofrequency-assisted liver resection: Technique and results

BackgroundRadiofrequency (RF)-assisted liver resection allows non-anatomical liver resection with reduced blood loss and offers the opportunity for a combination of resection and ablation. However, there are still concerns with regard to postoperative complications related to this technique. In the present study, we discuss the technical aspects of RF-assisted liver resections and analyse the rate of perioperative complications, focusing on post-hepatectomy liver failure (PLF), bile leak and abscess, and mortality. MethodsBetween 2001 and 2015, 857 consecutive open and laparoscopic elective RF-assisted liver resections for benign and malignant liver tumours were reviewed retrospectively to assess perioperative outcomes. ResultsMedian intraoperative blood loss was 130 mL, with 9.8% of patients requiring blood transfusion. Intra-abdominal collections requiring percutaneous drainage developed in 8.7% of all patients, while bile leak at resection margin developed in 2.8% of the cases. Major liver resection was performed in 34% of patients and the incidence of PLF was 1.5% with one directly related mortality (0.1%). ConclusionRF-assisted liver resection has evolved into a feasible and safe technique of liver resection with an acceptable incidence of perioperative morbidity and a low incidence of PLF and related mortality.

A Novel Technique of Laparoscopic Liver Resection Using Radiofrequency Ablation

Introduction: The gold standard treatment of early gallbladder carcinoma is radical cholecystectomy. This procedure involves en-block resection of the adjoining liver bed. Hemostasis control is the major concern during liver resection, particularly in laparoscopic approach. Mortality and morbidity are clearly associated with the amount of blood loss.1 The harmonic scalpel is commonly used for liver resection during the laparoscopic approach. However, this technique has been shown to have more incidence of bile leakage.2 Radiofrequency (RF) energy has been broadly used to ablate local unresectable liver tumor by causing coagulative necrosis of the liver parenchyma tissues.3 This alternating current also causes thrombosis and coagulation of the small blood vessels, which exhibits its potential in bloodless liver resection. RF-assisted liver resection shows minimal blood loss in human and animal model experiences.4–6 This novel technique is utilized during laparoscopic radical cholecystectomy to minimize blood loss in liver bed resection. The patient was a 38-year-old lady who presented with epigastric pain for 3 years. The pain was worsening. Abdominal ultrasound showed a large polypoidal mass measuring 2 cm within the gallbladder. Computed tomography of the abdomen confirmed the ultrasound finding showing a large polypoidal mass within the gallbladder without invasion to the liver. RF energy-assisted laparoscopic radical cholecystectomy was performed for her. Methods: This video illustrates the technique of laparoscopic radical cholecystectomy assisted by RF energy. First, the procedure was proceeded as laparoscopic cholecystectomy. The fundus of the gallbladder was retracted. Callot's triangle was dissected. Once the cystic vessels and duct were identified, they were clipped and divided. Endoloop was applied to the neck of gallbladder for better retraction later. Resection margin was marked with hook by electrocautery, which is 2 cm around the liver bed margin. RF energy was applied to the planned resection margin. Coagulative desiccation was performed using a cooled-tip RF probe and a 500 kHz generator (Radionics Europe, NV, Wettdren, Belgium). The RF probe was inserted 2 cm in depth. Once coagulative desiccation had been achieved, the probe was then advanced 1 cm along the resection margin. When hemostasis was secured with complete ablation of the resection margin, a sharp transaction of the coagulated plane was done by using scissors. No clamping of the vascular pedicles was necessary. Any bleeding from the resection margin during scissor transection was ablated again until satisfactory hemostasis was achieved. The estimated blood loss was less than 10 mL. Results: Postoperatively, patient's recovery was uneventful. No significant drop in hemoglobin was noted. The total ward stay was 3 days. The patient was back to normal daily activity in 5 days. Histopathologically, polyps within the gallbladder were consistent with a well-differentiated (polypoidal) adenocarcinoma. The gallbladder showed chronic cholecystitis with cholesterol polyps. Liver tissue showed no evidence of malignancy. The patient did not require any adjuvant therapy. Conclusion: RF ablation can be a useful adjunct in laparoscopic radical cholecystectomy during liver bed resection. This safe, fast, and simple technique is effective in minimizing blood loss. It potentially reduces the conversion rate from laparoscopic approach to open method once suspected early gallbladder is encountered during laparoscopic cholecystectomy. No competing financial interests exist. Runtime of video: 7 mins 10 secs

Radiofrequency-assisted liver resections for metastatic colorectal cancer: Technique and feasibility

Radiofrequency (RF)-assisted resection techniques are associated with minimal blood loss providing safe hemostasis of the transected liver 1-3 parenchyma. Different RF-assisted liver resection techniques have been developed. The presented RF technique is the sequentional coagulate-cut liver resection technique (?The Belgrade technique?) and the difference from other techniques is the way the electrode is used. A coagulate-cut liver resection cycle can be described as a process of creating a 30-mm long and 6-8 mm wide cylinder of coagulated and desiccated liver tissue by applying RF energy through the non-insulated tip of the electrode inserted into the liver parenchyma and then dividing the coagulated tissue by surgical scalpel or scissors. From January 2001 to January 2014, 830 RF-assisted liver resections were performed for various indications at the HPB unit of the Clinic for Digestive Surgery, Clinical center of Serbia, Belgrade. Among 830 liver resections, 470 resections were performed in 383 patients with colorectal cancer liver metastasis. Sixty-six patients experienced repeated liver resection ranging from a second to a fifth resection. The majority of patients had bi-lobar spread of the disease before the first liver resection was performed. No difference was found in the postoperative morbidity between the patients after the first, the second and the third liver resection (F=0.168; p=0.846). 90-days mortality was 5.7% after the repeated liver resections and 2.5% in patients with one liver resection (X2=2.278; 4,13 p=0.165). Single HPB unit experience has demonstrated that RF-assisted liver resection technique is feasible, safe and effective procedure in the management of patients with CRC liver metastasis.

Radiofrequency-Assisted Hepatic Resection

The only curative procedure to date for liver tumors is surgical resection, which remains a major procedure with marked morbidity and mortality. Radiofrequency (RF) has increasingly been used for both ablation and resection. On the basis of this technique, a new bipolar RF device, Habib 4X, has been developed and used clinically. We present our technique of liver resection with this device in a patient with colorectal liver metastases. A patient with situs inversus who had colorectal liver metastases in her left lobe underwent left lateral segmentectomy with the new device, a four-electrode bipolar resection device that uses RF energy for tissue necrosis. After laparotomy and intraoperative ultrasound, the plane resection was marked 1 cm away from the edge of the lesion. Coagulative desiccation was performed along this plane using this sealer connected to a RF generator. The necrosed band of parenchyma was then divided with a scalpel and resection completed. The length of the procedure was 105 minutes; resection time was 35 minutes. Total blood loss was 100 ml. No blood transfusions were required, and the patient was not admitted to the intensive care unit after surgery. The patient was discharged 10 days after surgery without any surgical complications. We think that RF-assisted liver resection with this new device is safe and effective. It is quicker than conventional RF and may reduce overall hospital stay in liver resection patients.

Radiofrequency-Assisted Liver Resection: Higher Incidence of Infectious Complications ?

Aim : To evaluate clinical experience with radiofrequency (RF)-assisted liver resection in non-cirrhotic and non-cholestatic patients with metastatic liver disease.Methods: A group of consecutive patients who underwent RF-assisted liver resection for metastatic liver disease was prospectively followed.Results : Between July 2005 and April 2008, 95 liver RF-assisted liver resections were performed, 71 of them for metastatic liver disease. The mean hospital stay was 14 (range 5–40) days. The mean operation time was 141 (range 64233) minutes. The mean duration of RF coagulation was 10 (range 9–12) minutes. A total of 37 complications in 24 (33%) patients were recorded, including 12 (16.9%) infected collections in resection line that had to be drained percutaneously. The 30-day postoperative mortality was zero.Conclusion : This study indicates that RF-assisted resection may have a benefit in decreasing peroperative blood loss and the number of blood transfusions. Nevertheless, an increased incidence of infectious complications and pleural effusions that required evacuation was noted.

Radiomorphology of the Habib Sealer-Induced Resection Plane during Long-Time Followup:A Longitudinal Single Center Experience after 64 Radiofrequency-AssistedLiver Resections

Background. Radiofrequency (RF-) assisted liver resection devices like the Habib sealer induce a necrotic resection plane from which a small margin of necrotic liver tissue remains in situ. The aim of the present paper was to report our long-time experience with the new resection method and the morphological characteristics of the remaining necrotic resection plane. Methods. 64 RF-assisted liver resections were performed using the Habib sealer. Followup was assessed at defined time points. Results. The postoperative mortality was 3,6% and morbidity was 18%. The followup revealed that the necrotic zone was detectable in all analyzed CT and MRI images as a hypodense structure without any contrast enhancement at all time points, irrespectively of the time interval between resection and examination. Conclusion. Liver resection utilizing radiofrequency-induced resection plane coagulation is a safe alternative to the established resection techniques. The residual zone of coagulation necrosis remains basically unchanged during a followup of three years. This has to be kept in mind when evaluating the follow up imaging of these patients.

Radiofrequency-Assisted Liver Resection in Patients With Hepatocellular Carcinoma and Cirrhosis: Preliminary Results

Radiofrequency (RF)-assisted liver resection has been shown to allow virtually bloodless procedures without the need for vascular exclusion maneuvers. The aim of this study was to evaluate the safety and feasibility of RF-assisted liver resection in cirrhotic patients with hepatocellular carcinoma (HCC) and, moreover, to assess whether the RF-assisted procedure influenced the outcomes in terms of morbidity and mortality. This retrospective study included 39 cirrhotic patients who underwent RF-assisted liver resection for HCC between September 2001 and March 2006. In this period, we performed 17 monosegmentectomies, 16 bisegmentectomies, 4 trisegmentectomies, and 2 right hepatectomies. We never performed vascular exclusion maneuvers. Blood transfusion was necessary in 3 cases. One patient died postoperatively because of untreatable hepatorenal syndrome. The morbidity rate was 23%. Among patients without postoperative morbidity (n = 30), the 4-year survival rate was 61% versus 23% in patients who experienced postoperative morbidity (n = 9; P < .05). The 4-year disease-free survival rate was 40% in patients without postoperative morbidity versus 10% in patients who experienced postoperative morbidity ( P = .05). Tumor dimension, number of lesions, and Child-Pugh class at surgery did not seem to significantly influence the 4-year overall survival ( P > .05). In conclusion, RF-assisted liver resection was a safe, feasible procedure associated with low morbidity and hospital mortality rates even in cases of liver cirrhosis. It is, in our opinion, highly recommended for patients with HCC not suitable for liver transplantation.

Radiofrequency‐Assisted liver resection in cirrhotic patients with hepatocellular carcinoma

Radio-frequency-assisted liver resection has been shown to allow virtually bloodless procedures without the need for vascular exclusion manoeuvres. Our primary end-point was to evaluate safety and feasibility of RF-assisted liver resection in cirrhotic patients with hepatocellular carcinoma. Our second end-point was to assess whether the RF-assisted procedure influence the outcome in terms of morbidity and mortality. A retrospective study was done of 55 cirrhotic patients who underwent RF-assisted liver resection for HCC at our Departments between September 2001 and October 2007. In the period of study 29 monosegmentectomies, 20 bisegmentectomies, 4 trisegmentectomies and 2 right hepatectomies were carried out. Vascular exclusion manoeuvres were never performed. One patient died post-operatively because of untreatable hepatorenal syndrome. Twelve patients out of 55 experienced 21 complications including complicated pleural effusion, intra-abdominal collection, hepatorenal syndrome, ascites, hematoma and biliary fistula. Post-operative liver failure occurred in one case (1.8%). In patients without post-operative morbidity (n = 43) the 4-year survival rate was 62% versus 24% in patients who experienced post-operative morbidity (n = 12) (P = 0.02). RF-assisted liver resection is a safe and feasible procedure associated with lower morbidity and hospital mortality rates even in case of liver cirrhosis.

Segmental liver resection in a child using intraoperative ultrasound-guided radiofrequency energy

Segmental surgical liver resection is still considered the only potentially curative option for patients with resectable liver tumors. Intraoperative bleeding may be a dangerous complication even in an expert's hands. A bloodless technique of radiofrequency (RF)–assisted segmental liver resection was performed in a 9-year-old girl with a mycobacterial spindle cell pseudotumor of the liver. Under intraoperative ultrasound guidance, the liver parenchyma was coagulated along the marked resection plane by a single “cooled-tip” RF electrode and then divided with a surgical knife. A nearly bloodless resection of the parenchyma was achieved within 25 minutes. The patient was discharged on the fifth postoperative day without complications. My early experience shows that RF-assisted liver resection offers a valuable additional option for bloodless removal of liver tumors in pediatric age.