Importance of eliminating portal flow to produce large intrahepatic lesions with interstitial laser coagulation.
BACKGROUND
Interstitial laser coagulation is a local treatment modality for solid tumours, such as liver metastases. Perfusion by the vascular system can transfer heat from the treatment site, thereby reducing the volume of destroyed tissue.


METHODS
This effect was investigated in a pig model (n = 10). Lesions were produced in the liver with four interstitial laser fibres (5 W per fibre for 6 min): (1) with flow through the liver (n = 9); (2) with the portal vein clamped (n = 8); and (3) with both hepatic artery and portal vein clamped (n = 6). The pigs were killed and the liver was dissected; lesions were assessed macroscopically and microscopically.


RESULTS
The volume of the lesion was significantly larger when portal flow was eliminated (30.6 versus 6.4 cm3, P < 0.001).


CONCLUSIONS
Hepatic blood flow substantially reduces the size of the lesion produced by laser coagulation. Portal flow should therefore be occluded during laser treatment to produce lesions of clinically relevant dimensions.
Heisterkamp
J
J
Department of Surgery, Erasmus University, Rotterdam, The Netherlands.
van Hillegersberg
R
R
Mulder
P G
PG
Sinofsky
E L
EL
IJzermans
J N
JN
D000818:Animals; D005260:Female; D017075:Laser Coagulation / Q000379:methods*; D008026:Ligation; D008099:Liver / Q000098:blood supply*; D011168:Portal System / Q000601:surgery*; D013552:Swine