The physiologic effect of the pneumoperitoneum on radiofrequency ablation

Smith, M; Mutter, Didier; Forbes, Lael; Mulier, Stefaan; Marescaux, J.

doi:10.1007/s00464-001-8235-2

Cited by 31 publications

(14 citation statements)

References 20 publications

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“…This could increase the ablation volume by RFA by reducing the "heat sink" effect of portal blood flow [74]. It also provides a better survey of the peritoneal cavity to exclude extrahepatic metastases.…”

Section: Approaches Of Rfamentioning

confidence: 99%

Current status of radio-frequency ablation for hepatocellular carcinoma

Fan

2004

Eur Surg

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Zusammenfassung. Grundlagen: Die Radiofrequenz-Ablation (RFA) ist die zuletzt entwickelte und häufig angewendete lokal-ablative Therapie für Lebertumore. Sie ermöglicht die effektive Tumorablation bei größtmöglicher Erhaltung von normalem Leberparenchym. In den letzten Jahren kam die RFA bei Patienten mit hepatozellulärem Karzinom (HCC) stark vermehrt zum Einsatz. Die therapeutische Wirkung dieser lokal-ablativen Behandlung muss jedoch gegenüber ihren Risiken und einem möglichen lokalen Therapieversagen abgewogen werden.Methodik: Diese kritische Übersicht konzentriert sich auf den gegenwärtigen Stand der RFA bei HCC mit besonderer Beachtung ihrer Indikationen, der Methodik, der Risiken, des lokalen Therapieversagens und der Verbesserung der Überlebenszeit.Ergebnisse: Obwohl die Ergebnisse der meisten klinischen Studien zur RFA optimistisch scheinen, sollten die damit verbundenen Komplikationen und Tumorrezidive nicht übersehen werden. Sorgfältige Patientenauswahl, genaueste RFA-Techniken und prompte Behandlung von Residual-und Rezidivtumoren sind notwendig, um ein besseres Ergebnis nach RFA sicherzustellen.Schlussfolgerungen: Bis vor kurzem gab es keine ausreichenden Beweise dafür, dass die RFA andere Behandlungsmethoden des HCC ersetzen kann. Überzeugendere Daten aus randomisierten Studien sind notwendig, um ein Behandlungsprotokoll für die RFA bei Patienten mit HCC zu etablieren.Schlüsselwörter: Radiofrequenz-Ablation, hepatozelluläres Karzinom.Summary. Background: Radio-frequency ablation (RFA) is the latest developed and widely practised local ablation therapy for liver tumours. It has the merit of effective tumour ablation and preservation of the maximal normal liver parenchyma. In the past few years, there has been tremendous expansion in the application of RFA for hepatocellular carcinoma (HCC) patients. However, the therapeutic effect of this local-ablation treatment needs to be balanced against its risks and possible local failure.Methods: This review focuses on the current status of RFA for HCC, with attention to its indications, approaches, risks, local failure, and survival benefit.Results: Although the results of most clinical studies of RFA seem optimistic, the associated complication and tumour recurrence should not be overlooked. Careful patient selection, meticulous RFA techniques, and prompt treatment of residual and recurrent tumours are necessary to ensure a better outcome after RFA.Conclusions: Until recently, there has been no strong evidence showing that RFA can replace any treatment modalities in the management of HCC. Nonetheless, more convincing evidence by randomised trials is required for the establishment of a treatment protocol of RFA for HCC patients.

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Section: Approaches Of Rfamentioning

confidence: 99%

Current status of radio-frequency ablation for hepatocellular carcinoma

Fan

2004

Eur Surg

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“…Since the creation of a pneumoperitoneum leads to an upward movement of the diaphragm, there is in fact minimal movement of the liver during a laparoscopic procedure, further facilitating needle placement (8).…”

Section: Introductionmentioning

confidence: 99%

A family of new instruments for laparoscopic radiofrequency ablation of malignant liver lesions

Raggi

Schneider

Härtl

et al. 2006

Minimally Invasive Therapy & Allied Technologies

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Primary and secondary liver tumors may be treated with radiofrequency ablation (RFA) to improve tumor control and to increase patient survival. Lesions are punctured percutaneously or during open surgery. However, not all of the lesions are accessible percutaneously due to their localization: Adjacent structures could be endangered and/or the treatment would cause severe pain. Open surgery is an option in these cases but significantly more invasive. Laparoscopic RFA (LRFA) is an additional possibility in those cases: It offers a better access to difficult lesions than via the percutaneous route and is also less invasive than open surgery. The precision of targeting, however, in LRFA still has to be improved. In an in-vivo feasibility study we used a tumor mimic model in pigs to examine the applicability of laparoscopic RFA in combination with laparoscopic ultrasound using a set of dedicated new instruments to handle the RFA probe. To increase the ablation volume, the liver blood flow was reduced performing a Pringle maneuver. It is demonstrated that this set of specially designed instruments is indeed applicable and facilitates the targeting of liver lesions of any localization. Accordingly, it could significantly enlarge the applicability of LRFA.

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“…Pneumoperitoneum per se has the advantage to decrease the blood flow and increase the area of ablation [17].…”

Section: Lrfa Advantagesmentioning

confidence: 99%