Microwave Tissue Coagulator in Liver Resection for Cirrhotic Patients

Abstract

The use of the microwave tissue coagulator was studied on 20 consecutive elective hepatic resections carried out for symptomatic hepatocellular carcinoma with liver cirrhosis. The mean operative blood loss (excluding one patient with hepatic vein injury) was 1132 mL. Five patients required no blood transfusion. The average time taken to coagulate the anticipated liver transection plane was less than 15 min. Apart from the complications similar to those occurring in hepatic resections for cirrhotic patients, higher incidences of intra‐abdominal sepsis (20%), sympathetic pleural effusion in the absence of chest or intra‐abdominal sepsis (20%), and persistent fever lasting more than 1 week (40%) were encountered. It was considered that these complications were related to the coagulated tissue present in the liver remnants (mean depth of tissue coagulation = 3.8 mm) and concluded that although the hospital mortality rate of 10% and the mean operative blood loss of 1132 mL were acceptably low, microwave liver surgery carried a high morbidity rate which is a drawback in major hepatic resectional surgery.

Hepatic resection using the harmonic scalpel

“…It has been reported that the microwave tissue coagulator method can induce bile leakage or infection due to necrosis detachment of the cut margin of the residual liver. 9 Since the coagulation temperature with a harmonic scalpel is less than 100°C, being lower than that of the electro-and laser surgical techniques, tissue damage is minimal. 11 Indeed, the necrotic changes at the cut margin of the residual liver following surgery with our technique were minimal and no complications in association with the harmonic scalpel, such as postoperative bleeding, bile leakage, and abscess formation at the cut margins, were observed.…”

“…Various techniques have been reported for division of the liver, such as blunt dissection, 5 the use of an ultrasonic surgical aspirator (CUSA) or water-jet scalpel, 8 and the microwave tissue coagulator method. 9 The CUSA and water-jet scalpel can divide the liver by fracture aspiration of the liver parenchyma, but they cannot be used for coagulation or cutting. Unlike these instruments, the harmonic scalpel can be used for both coagulation and cutting, thereby reducing the time needed to divide the liver.…”

Oncolytic Herpes Viral Therapy is Effective in the Treatment of Hepatocellular Carcinoma Cell Lines

“…While hepatic resection remains the best curative option, there are many instances where curative resection cannot be performed including advanced patient age, underlying severe comorbidities or poor liver function, and locally advanced disease. While numerous alternative treatment modalities that have been employed in this setting including percutaneous microwave coagulation therapy (PMCT), percutaneous ethanol infusion (PEI), regional hyperthermia therapy, interstitial radiotherapy and radiofrequency interstitial tissue ablation (RITA, RFA), none have yet been demonstrated to improve patient survival (47)(48)(49)(50)(51)(52)(53). It is clear that novel therapies are needed.…”

Techniques for Liver Resection

“…Microwave tissue coagulation has been employed to induce tissue coagulation by insertion of the microwave probes before transection is carried out 58 . However, there was a much higher incidence of bile leakage (27% vs. 3%), when compared with the clamp crushing method 59 .…”