A Simple Method to Avoid Bile Duct Injury during Percutaneous Radiofrequency Ablation Therapy for Hepatocellular Carcinoma

Abstract

Hepatocellular carcinoma represents a major global health burden. Its treatment is often complicated by the anatomical location of tumors, which can lead to adverse outcomes. Radiofrequency ablation has recently gained attention as a safe method for treating hepatocellular carcinoma, but only in tumors that are not adjacent to bile ducts. Here, we report a new method for cooling the bile duct during radiofrequency ablation therapy, in which the outer jacket of an elastor needle was fixed and flash-cooled with chilled saline. This method was applied in a patient with hepatocellular carcinoma tumors near the main bile duct. The patient underwent successful radiofrequency ablation with bile duct cooling. The advantages of this method include low medical cost, simpler securing of nonexpanded bile ducts, and simultaneous removal upon termination of the radiofrequency ablation therapy. Bile duct complications associated with radiofrequency ablation typically have delayed onset. Computed tomography examination 2 months after treatment showed no bile duct injury in this case.

Iatrogenic Complications and Management of Biliary Interventions

“…Because bile duct damage is very serious in the hilar region, central liver tumors are also considered to be a contraindication for thermoablation. 12 Various mitigating measures have been reported, such as cooling the tissue by infusing chilled saline through an endoscopic nasobiliary drainage tube or percutaneous transhepatic cholangiodrainage tube. 12 Irreversible electroporation is a nonthermal emerging ablative modality that causes cell death by direct pulsating currents and thus has not shown to cause bile duct injury.…”

“…12 Various mitigating measures have been reported, such as cooling the tissue by infusing chilled saline through an endoscopic nasobiliary drainage tube or percutaneous transhepatic cholangiodrainage tube. 12 Irreversible electroporation is a nonthermal emerging ablative modality that causes cell death by direct pulsating currents and thus has not shown to cause bile duct injury. 13 Interstitial brachytherapy is a modality in which seeds, ribbons, or capsules containing radiation are placed internally into a tumor and bypass the heat sink effect encountered in thermal ablation, which would allow for treatment of tumor near the hilum.…”

Fiberbots: Robotic fibers for high-precision minimally invasive surgery

“…Exemplar cases include hepatic resections due to colorectal metastasis, where the primary objective involves excising cancerous liver tissue with recommended large optimal margins (resulting in removal of >1-cm healthy tissue surrounding the tumor) to minimize the risk of cancer recurrence post-operatively ( 1 , 2 ) . Balancing the resection position is crucial, as excessive liver tissue removal can lead to postoperative complications or even liver failure ( 3 ) . The tumor’s proximity to critical structures such as the bile duct will additionally complicate achieving wide margins and safe removal of the tumor ( 4 ) .…”