Anaesthetic experience with laparoscopic cryotherapy. A new technique for treating liver metastases.
BACKGROUND
Laparoscopic cryotherapy is a new technique for treating hepatic tumors that obviates the need for a laparotomy and may reduce the amount of surgical trauma and heat loss associated with the open technique. Liquid nitrogen is applied to the tumor via a cryoneedle probe introduced through a laparoscopic port. The aim of this study was to assess the effect on body temperature and the hematological and biochemical changes associated with this technique.


METHODS
Five patients who underwent this procedure were studied prospectively under a standardized general anaesthetic. Core and peripheral temperature were measured during the procedure, and blood samples were taken for hematological and biochemical analysis.


RESULTS
Freezing time ranged 19-57 min and measured blood loss 0-1000 ml. In one case, bleeding resulted from hepatic surface cracking. Three patients required a blood transfusion. The mean fall in both nasopharyngeal and right atrial temperature was 0.4 degree C. Postoperatively, all patients showed a large rise in alanine aminotransferase (ALT) and a fall in platelet count. A systemic inflammatory response syndrome was seen in some cases, but all patients survived to hospital discharge.


CONCLUSIONS
Laparoscopic hepatic cryotherapy can be performed without significant temperature changes, but it entails significant morbidity.
Wallis
C B
CB
Department of Anaesthetics, Western General Hospital, Edinburgh, Scotland.
Coventry
D M
DM
D000368:Aged; D000769:Anesthesia, Inhalation / Q000379:methods; D003452:Cryosurgery / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D006863:Hydrogen-Ion Concentration; D010535:Laparoscopy / Q000379:methods*; D008113:Liver Neoplasms / Q000556:secondary / Q000628:therapy*; D008875:Middle Aged; D011446:Prospective Studies