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Laparoscopy-Guided Transthoracic Transdiaphragmatic Radiofrequency Ablation for Hepatic Tumors Located Beneath the Diaphragm

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Title: Laparoscopy-Guided Transthoracic Transdiaphragmatic Radiofrequency Ablation for Hepatic Tumors Located Beneath the Diaphragm
Other Titles: Laparoscopic transdiaphragmatic RFA for hepatic tumor
Authors: Tanaka, Kimitaka Browse this author →KAKEN DB
Kojima, Tetsufumi Browse this author
Hiraguchi, Etsuo Browse this author
Hashida, Hideaki Browse this author
Noji, Takehiro Browse this author →KAKEN DB
Hirano, Satoshi Browse this author →KAKEN DB
Keywords: Laparoscopic surgery
Radiofrequency ablation
Transthoracic transdiaphragmatic approach
Hepatic tumor
Diaphragmatic hernia
Issue Date: 18-Mar-2016
Publisher: Mary Ann Liebert
Journal Title: Journal of laparoendoscopic & advanced surgical techniques
Volume: 26
Issue: 3
Start Page: 180
End Page: 184
Publisher DOI: 10.1089/lap.2015.0380
PMID: 26859794
Abstract: Background: It is often difficult to perform percutaneous radiofrequency ablation (RFA) for hepatic tumors beneath the diaphragm. Diaphragmatic thermal damage is one of the fatal late complications of percutaneous transdiaphragmatic RFA. Our experience with laparoscopic transthoracic transdiaphragmatic intraoperative RFA (LTTI-RFA) for hepatic tumors beneath the diaphragm is reported. Methods: Ten patients who underwent LTTI-RFA from 2009 to 2012 were evaluated. Two cases had concomitant partial hepatectomy, and one underwent RFA for two tumors at the same time. The diagnosis was hepatocellular carcinoma in eight cases and metastatic hepatic tumors in two cases. Nine of eleven tumors were located at segments 7 and 8. Nine tumors were less than 20 mm in diameter. The patients were placed in the half left lateral decubitus position with single-lumen tube intubation. After placement of four abdominal ports, a 12-mm port was inserted in the fourth or fifth intercostal space into the diaphragm. The tumor was ablated by an RFA needle through the port. The routine follow-up consisted of laboratory tests and abdominal imaging every 3-6 months. Results: The median operation time for only one tumor was 137 minutes (range, 105-187 minutes). The median number of times for ablation was three. Severe postoperative complications (>Clavien-Dindo IIIa) were observed in one case (right upper limb paralysis). The median follow-up period was 35 months (range, 11-43 months). There was no local tumor progression. Recurrent hepatic tumor appearance occurred in other parts of the liver in 6 of the 11 patients. Conclusions: Laparoscopic transthoracic transdiaphragmatic RFA is an acceptable procedure with a low rate of local recurrence.
Rights: Final publication is available from Mary Ann Liebert, Inc., publishers
Type: article (author version)
Appears in Collections:北海道大学病院 (Hokkaido University Hospital) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 田中 公貴

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