*Laparoscopic treatment for hepatocellular carcinoma

  1. Laparoscopic microwave coagulation thearpy (LMCT) for the treatment of hepatocellular carcinoma

    A low echoic mass with a diameter of approximately 2 cm is located just beneath the liver surface of the left lobe by abdominal ultrasound (arrow).













    This tumor is clearly enhanced by CT arteriography (CTA, left) as a hypervascular mass that is located at the subsegment 3 (S3) of the liver (arrow). It is demonstrated to be scanty of portal blood supply (arrow) by CT during arterial portography (CTAP, right). These imaging characteristics are considered to be typical for the advanced type of hepatocellular carcinoma.






    Intraoperative photograph (left two-third) demonstrating laparoscopic microwave coagulation therapy (LMCT). A probe for laparoscopic ultrasound (LUS) is located on liver surface (left). A nodule of hepatocellular carcinoma inside the liver is punctured with a PTCD (percutaneous transhepatic cholangio-drainage) needle (middle) as a guide needle. A microwave generator needle (right) is inserted into the liver along the PTCD needle. LUS image is shown at the right one-third.











    Postoperative contrast enhancement CT for detecting a negatively enhanced area of LMCT in the subsegment 3 of the left lobe of the liver (arrow). Note that a sufficient therapeutic margen is obtained when compared to the preoperative CT figure shown above. The LMCT therapeutic session has been competed and the patient is now disease free for more than 2 years.












    Needles for laparoscopic microwave coagulation therapy (LMCT) of various lengths are shown. The area of 1.5 cm in diameter and 3.0 cm in depth is to be coagulated by this type of microwave needle.











    References
    1. Yamanaka N, Okamoto E, Tanaka T, Oriyama T, Fujimoto J, Furukawa K, Kawamura E. Laparoscopic microwave coagulonecrotic therapy for hepatocellular carcinoma. Surg Laparosc Endosc 1995; 5: 444-9.
    2. Ido K, Isoda N, Kawamoto C, Hozumi, M, Suzuki T, Nagamine N, Nakagawa Y, Ono K, Hirota N, Hyodoh H, Kimura K. Laparoscopic microwave coagulation therapy for solitary hepatocellular carcinoma performed under laparoscopic ultrasonography. Gastrointest Endosc 1997; 45: 415-20.


  2. Laparoscopic radiofrequency ablation therapy (LRFA) for the treatment of hepatocellular carcinoma


    The thermal ablation catheter (Trademark: RITA) for laparoscopic radiofrequency ablation therapy (LRFA) is shown.













    A tip of the thermal ablation catheter with the prongs deployed. Small thermocouples embedded near the tips of the prongs allow monitoring of temperature during and after the ablation process. A spherical area with 3.0 cm in diameter is to be ablated with this device.












    A hypervascular mass at arterial phase after bolus infection of contrast medium is detected by computed tomography (CT) in the left lobe of the liver. It is obviously located on liver surface.












    The same tumor reveals hypervascularity by magnetic resonance imaging (MRI) with gadrinium enhancement. Note that no other intrahepatic metasitasis is detectable.













    After LRFA, the tumor no longer revealed hypervascularity at arterial phase with sufficient safety margins. Tumor residue is thus not detectable from this picture.












    After LRFA, MRI with gadrinium enhancement revealed no vascularity other than a round demarcating margin surrounding coagulated mass by LRFA. This case showed no recurrence of the HCC for more than 2 years after this LRFA procedure.












    References
    1. Cuschieri A, Bracken J, Boni L. Initial experience with laparoscopic ultrasound-guided radiofrequency thermal ablation of hepatic tumours. Endoscopy 1999; 31: 318-21.
    2. Siperstein A, Garland A, Engle K, Rogers S, Berber E, String A, Foroutani A, Ryan T. Laparoscopic radiofrequency ablation of primary and metastatic liver tumors. Technical considerations. Surg Endosc 2000; 14: 400-5.


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