These preliminary results suggest CE-IOUS is an essential tool prior to liver resection for metastases.

Despite the fact that NOTES has just recently been introduced, the technique has already gained considerable clinical application. Transvaginal hybrid NOTES cholecystectomy is a practicable and safe alternative to laparoscopic resection even in obese or older patients.

Institutional review board approval and patient informed consent were obtained. Use of a multipolar radiofrequency (RF) ablation device in patients with hepatic malignancy was prospectively evaluated with regard to feasibility, achieved ablation zone size and shape, technical effectiveness, and complications. Nineteen malignant liver tumors were treated with the multipolar resistance-controlled RF ablation system, with which up to three internally cooled bipolar coagulation electrodes can be operated simultaneously. Postinterventional imaging was performed with dynamic contrast material-enhanced magnetic resonance (MR) imaging and MR imaging-based three-dimensional planimetry. Complete tumor destruction was achieved in 18 of 19 tumors. Mean ablation zone volume was 52 mL +/- 45 (standard deviation). Thirteen patients were treated with a percutaneous approach; six, with an intraoperative approach. Maximum ablation size was 91 x 62 x 79 mm with the percutaneous and 73 x 98 x 74 mm with the intraoperative approach. Of the 18 completely evaluable ablation zones, 13 were concentric, two were moderately eccentric, two were eccentric, and one was wedge-shaped. The multipolar RF ablation device achieves large ablation zones and has high technical effectiveness in treating hepatic tumors.

Portal fields lead to more heat sink than hepatic veins. The effects decreased with the distance between vessel and applicator tip, but less so for portal fields. The 2 vessel types induced considerably different shape alterations of the ablation zones. These results were not dependent on vessel size. This should be considered in the planning of thermal tumor ablations.

ObjectiveTo assess the effect of combined laser-induced thermotherapy (LITT) and hepatic arterial embolization with degradable starch microspheres (DSM) on tumor response and intrahepatic temperature distribution in rats with liver tumors. Summary Background DataLaser-induced thermotherapy is a promising in situ ablation technique for malignant liver tumors. However, clinical use is still limited, mainly because of the small size of the inducible coagulation necroses. This results in insufficient tumor destruction. MethodsColon carcinoma CC531 was implanted in 60 WAG rat livers. Fourteen days later, a silicon catheter was implanted in the hepatic artery for DSM administration. Tumors were exposed to 1064 nm Nd:YAG laser light at 2 watts for 10 minutes from a diffuser tip applicator placed in the tumor. The animals were randomized into a sham-operated control (group I) and three test groups. Group II received DSM alone, group III received LITT alone, and group IV received DSM ϩ LITT. Tumor control was examined 1, 7, and 14 days after treatment. ResultsA complete tumor remission was achieved in all rats treated with LITT ϩ DSM (group IV). In contrast, tumor progression was seen in animals treated with LITT alone (group III) or DSM alone (group II), as well as in the sham-operated controls (group I). ConclusionsThe authors' results suggest that the combination of LITT and DSM considerably increases the efficacy of LITT in the treatment of liver metastases in the rat.Laser-induced thermotherapy (LITT) or interstitial laser thermotherapy is an in situ ablation technique for the treatment of malignant tumors of the liver.

Minimal vascular flows of ≥1 ml/min cause a significant heat sink effect in hepatic RFA ex vivo. A lower limit for volumetric flow rate was not found. The maximum of the heat sink effect was reached at a flow rate of 10 ml/min and remained stable for flow rates up to 1,500 ml/min. Hepatic inflow occlusion should be considered in RFA close to hepatic vessels.

The feasibility and safety of percutaneous laser-induced thermotherapy (LITT) of liver metastases in an open lowfield magnetic resonance imaging (MRI) system combined with microsphere-modulated blood flow reduction were tested. Nd:YAG laser therapy with an internally cooled laser applicator was performed under local anesthesia on 20 patients with 34 liver metastases. To increase the effectivenes of LITT, degradable starch microspheres were injected into the proper hepatic artery through an MRvisible catheter initially inserted under fluoroscopy. Near real-time imaging was used for positioning the laser applicator. A T1-weighted gradient-echo breath-hold sequence was used for catheter localization and temperature monitoring. The volumes of the liver metastases and the thermonecroses were determined. MRI-guided LITT could be performed in all patients with no clinically relevant complications. Intraprocedural imaging underestimated the extent of thermonecrosis. In conclusion, percutaneous LITT of liver metastases after injection of starch microspheres is both technically feasible and safe in an open MRI system. J. Magn. Reson. Imaging 2001; 13:31-36.

The feasibility and safety of percutaneous laser‐induced thermotherapy (LITT) of liver metastases in an open low‐field magnetic resonance imaging (MRI) system combined with microsphere‐modulated blood flow reduction were tested. Nd:YAG laser therapy with an internally cooled laser applicator was performed under local anesthesia on 20 patients with 34 liver metastases. To increase the effectivenes of LITT, degradable starch microspheres were injected into the proper hepatic artery through an MR‐visible catheter initially inserted under fluoroscopy. Near real‐time imaging was used for positioning the laser applicator. A T1‐weighted gradient‐echo breath‐hold sequence was used for catheter localization and temperature monitoring. The volumes of the liver metastases and the thermonecroses were determined. MRI‐guided LITT could be performed in all patients with no clinically relevant complications. Intraprocedural imaging underestimated the extent of thermonecrosis. In conclusion, percutaneous LITT of liver metastases after injection of starch microspheres is both technically feasible and safe in an open MRI system. J. Magn. Reson. Imaging 2001;13:31–36. © 2001 Wiley‐Liss, Inc.