title: Laparoscopic cryoablation of hepatic metastases.
abstract: OBJECTIVE
  To evaluate the feasibility of laparoscopic cryoablation for the management of hepatic metastases.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Nine patients were evaluated by laparoscopy for planned laparoscopic cryoablation of hepatic metastases at The Cleveland Clinic Foundation, Cleveland, Ohio, from April 1996 to May 1997.
  
  
  RESULTS
  Laparoscopic exploration revealed diffuse extrahepatic disease not identified by preoperative studies in 2 patients. The remaining 7 patients underwent 9 cryotherapy sessions. During 4 of the cryotherapy sessions, ultrasonography demonstrated unrecognized additional treatable hepatic lesions. An average of 3 lesions (range, 2-5) were treated. Operative time averaged 3.5 hours with a mean intraoperative blood loss of 235 mL. One patient had significant intraoperative hemorrhage requiring conversion to open hepatic resection for bleeding control. Eight of the 9 patients tolerated normal diets and ambulated independently on the first postoperative day. Following cryotherapy, 4 of the patients developed fever without an infectious source. One patient developed a postoperative bile leak requiring percutaneous biliary stenting. Postoperative hospital stay averaged 4.5 days (median, 4 days; range, 2-14 days). At a mean follow-up of 9 months, 4 of the 7 patients treated are alive without evidence of disease, 2 are alive with disease, and 1 patient with a pancreatic primary tumor has died of disease.
  
  
  CONCLUSIONS
  Laparoscopy with laparoscopic ultrasonography is a useful tool in evaluating patients with hepatic metastases. Laparoscopic cryoablation is feasible and may result in lower postoperative morbidity in patients receiving aggressive treatment for inoperable hepatic metastases.
authors.affiliation: Department of General Surgery, The Cleveland Clinic Foundation, Ohio, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Iannitti
authors.forename: T
authors.initials: T
authors.lastname: Heniford
authors.forename: J
authors.initials: J
authors.lastname: Hale
authors.forename: S
authors.initials: S
authors.lastname: Grundfest-Broniatowski
authors.forename: M
authors.initials: M
authors.lastname: Gagner
mesh_terms: D003452:Cryosurgery / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D010535:Laparoscopy; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D012189:Retrospective Studies