Laparoscopic Radiofrequency Ablation for Hepatocellular Carcinoma

Abstract

Radiofrequency ablation (RFA) is one of the best curative treatments for hepatocellular carcinoma in selected patients, and this procedure can be applied either percutaneously or laparoscopically. Although the percutaneous approach is less invasive and is considered the first choice, RFA with laparoscopic guidance is highly recommended for patients with a relative contraindication for percutaneous RFA, such as lesions adjacent to the gastrointestinal tract, gallbladder, bile duct and heart. Recent advances in laparoscopic ultrasound have widened the indication for laparoscopic ablation. In the present paper, we review the indications, advantages, prognosis and safety of laparoscopic RFA for hepatocellular carcinoma.

Clinical outcomes of laparoscopic radiofrequency ablation of single primary or recurrent hepatocellular carcinoma (≤3 cm)

“…Asahina et al [15] suggested that mandatory use of laparoscopic US could prevent thermal damage to intrahepatic vessels and bile ducts. Furthermore, effective tumor ablation without a “heat sink” effect could be possible.…”

Laparoendoscopic single-site liver resection: a preliminary report of 12 cases

“…Laparoscopic radiofrequency ablation is another excellent option for malignant tumors smaller than 3 cm because it results in a favorable and comparably long-term patient survival compared with surgical resection [34,35]. An overlap in the functionality of LESS and laparoscopic radiofrequency might exist.…”

Novel Non-Trocar Technique for Laparoscopic Radiofrequency Ablation

“…Moreover, the risk of hemorrhage and dissemination from protruding HCC on the surface of the liver is very high with percutaneous RFA [8,9]. In such cases, laparoscopic RFA has been carried out safely [4]. Without US guidance, exact and safe insertion of needles is difficult into nodules indiscernible from the liver surface and into those located just below the diaphragm.…”

“…Asahina et al [4,5] have developed a sector type ultrasonic probe (end-fire type), which is inserted through a 12-mm trocar, and although safe and accurate ablation is possible therewith, a 20-cm needle is difficult to handle. When a cool-tip type probe is used, a 25-cm long needle is requisite; however, such a needle may carry the risk of unnecessary overablation of small HCC, in that it can ablate only nodules 3 cm in diameter.…”

“…The former is superior to the latter because of its minimally invasive surgical procedure and the cosmetically more esthetic surgical scar [3]. When a laparoscopic ultrasound probe is inserted through a trocar, it is difficult to use the insertion point made by the probe or to attach and slide an ablation needle along the groove of the probe into the abdominal cavity because of the longitudinal dissociation between the needle and the probe [4,5]. We have developed a novel insertion method, a non-trocar technique (NTT), for laparoscopic RFA with the use of a convex scanning probe, whereby an ablation needle accurately and easily punctures the target tumor in the liver.…”