Laparoscopic Microwave Coagulation Therapy for Hepatocellular Carcinoma

Seki, Shuichi; Sakaguchi, Hiroki; Kadoya, Hirokazu; Morikawa, Hiroyasu; Habu, Daiki; Nishiguchi, Shuhei; Shiomi, Susumu; Kitada, Takuya; Kuroki, Tetsuo

doi:10.1055/s-2000-9014

Cited by 61 publications

(40 citation statements)

References 15 publications

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“…To date, only a few cases of laparoscopic RITA of HCC have been reported [6,8,14,33,34,38] and a few cases of laparoscopic microwave coagulation therapy have been published [16,37]. In our series, 27% of 86 patients submitted to L-LUS had new malignant nodules, which required additional treatment during the same laparoscopic procedure.…”

Section: Discussionmentioning

confidence: 74%

Safety and efficacy of laparoscopic radiofrequency of hepatocellular carcinoma in patients with liver cirrhosis

et al. 2003

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Background: The optimal treatment for hepatocellular carcinoma (HCC) is surgical resection. However, only a small percentage of patients are operative candidates. Percutaneous radiofrequency interstitial thermal ablation (RITA) has been shown to be efficacious in the treatment of unresectable HCC. Recent advances in laparoscopic ultrasound have greatly improved the accuracy in detecting intrahepatic HCC nodules, many of which were missed by computed tomography. Our objective was to introduce a novel operative combination of laparoscopic ultrasound with laparoscopic RITA in the treatment of HCC. Methods: Eighty-eight patients with HCC in liver cirrhosis were submitted to laparoscopic RITA under sonographic guide. Most patients were in Child's A class of liver function. Patients with large tumors (>5 cm), portal vein thrombosis, or severe liver disease (Child's C class) were excluded. Results: The laparoscopic RITA procedure was completed in 86 of 88 patients (98% feasibility rate). Laparoscopy with laparoscopic ultrasound identified 23 new malignant lesions (27%) in comparison with the results of preoperative imaging. A total of 127 lesions were treated by RITA. There was no operative mortality. Sixty-one patients had no complication (71%). After a mean follow-up of 14.3 ± 11.6 months, a complete response with a 100% necrosis was achieved in 70 of 83 patients examined (86%). During follow-up, 9 patients (11%) locally recurred at the RITA site and 38 patients (46%) had new malignant nodules. Conclusions: Laparoscopic RITA of HCC proved to be a safe and effective technique in the short term. This technique may be indicated when the percutaneous approach to the lesion is very difficult or if the patient is too ill to undergo laparotomy.

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Section: Discussionmentioning

confidence: 74%

Safety and efficacy of laparoscopic radiofrequency of hepatocellular carcinoma in patients with liver cirrhosis

et al. 2003

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“…Over the past two decades, considerable improvements in percutaneous/laparoscopic MWA techniques have resulted in improved outcomes. [8][9][10] MWA has been predominantly used in China and Japan, [11][12][13] but the technique is now gaining popularity in the West.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous thermal ablation for primary hepatocellular carcinoma: A systematic review and meta‐analysis

Chinnaratha

Chuang

Fraser

et al. 2016

J of Gastro and Hepatol

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“…[28][29][30] Compared to sequential ablations, simultaneous multiple applicator ablations offer the potential for synergistic heating between applicators, leading to faster ablation of targets, however, there is a small risk of skin burns as has been observed in some clinical studies. [31][32][33] A recent study by Sindram et al, reported that the occurrence of skin burns is a function of the array insertion depth and the minimum interapplicator spacing, in the case of nonparallel implants, 34 and could be avoided by placing constraints on insertion depth and applicator spacing.…”

Section: Introductionmentioning

confidence: 99%

Multiple applicator hepatic ablation with interstitial ultrasound devices: Theoretical and experimental investigation

et al. 2012

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Purpose: To evaluate multiple applicator implant configurations of interstitial ultrasound devices for large volume ablation of liver tumors. Methods: A 3D bioacoustic-thermal model using the finite element method was implemented to assess multiple applicator implant configurations for thermal ablation with interstitial ultrasound energy. Interstitial applicators consist of linear arrays of up to four 10 mm-long tubular ultrasound transducers, each under separate and dynamic power control, enclosed within a water-cooled delivery catheter (2.4 mm OD). The authors considered parallel implants with two and three applicators (clustered configuration), spaced 2-3 cm apart, to simulate open surgical placement. In addition, the authors considered two applicator implants with applicators converging and diverging at angles of ∼20• , 30• , and 45• to simulate percutaneous placement. Heating experiments (10-15 min) were performed and compared against simulations employing the same experimental parameters. To estimate the performance of parallel, multiple applicator configurations in an in vivo setting, simulations were performed taking into account a range of blood perfusion levels (0, 5, 12, and 15 kg m −3 s −1 ) that may occur in tumors of varying vascularity. The impact of tailoring the power supplied to individual transducer elements along the length of applicators is explored for applicators inserted in non-parallel (converging and diverging) configurations. Thermal dose (t 43 > 240 min) and temperature thresholds (T > 52• C) were used to define the ablation zones, with dynamic changes to tissue acoustic and thermal properties incorporated within the model. Results: Experiments in ex vivo bovine liver yielded ablation zones ranging between 4.0-5.6 cm × 3.2-4.9 cm, in cross section. Ablation zone dimensions predicted by simulations with similar parameters to the experiments were in close agreement (within 5 mm). Simulations of in vivo heating showed that 15 min heating and interapplicator spacing less than 3 cm are required to obtain contiguous, complete ablation zones. The ability to create complete ablation zone profiles for nonparallel implants was illustrated by tailoring applied power levels along the length of applicators. Conclusions: Parallel implants consisting of three interstitial ultrasound applicators in a triangular configuration yield complete ablation zones measuring up to 6.2 cm × 5.7 cm after 15 min heating. At larger interapplicator spacing, the level of blood perfusion in the tumor may yield indentations along the periphery of the ablation zone. Tailoring applied power along the length of the applicator can accommodate for nonparallel implants, without compromising safety.

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Laparoscopic Microwave Coagulation Therapy for Hepatocellular Carcinoma

Abstract: LMCT under local anesthesia is a minimally invasive and effective therapy when carried out on a single occasion to treat HCCs located near the liver surface, and it can be safely performed under direct visual guidance.

Cited by 61 publications

References 15 publications

Safety and efficacy of laparoscopic radiofrequency of hepatocellular carcinoma in patients with liver cirrhosis

Safety and efficacy of laparoscopic radiofrequency of hepatocellular carcinoma in patients with liver cirrhosis

Percutaneous thermal ablation for primary hepatocellular carcinoma: A systematic review and meta‐analysis

Multiple applicator hepatic ablation with interstitial ultrasound devices: Theoretical and experimental investigation

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