Augmenting the ablative effect of liver electrolysis: using two electrodes and the pringle maneuver.
Several methods of liver tumor ablation have been investigated, and these include the novel technique of electrolysis. Electrolysis is slower than other forms of ablative therapy. This study determined methods of increasing the ablative effect of electrolysis. Domestic white pigs were divided. One group received electrolysis using two electrode catheters, and in the other group a concurrent intermittent Pringle maneuver was performed to induce intermittent ischemia. The effect of two electrode catheters versus a single electrode catheter was compared, and the effect of the Pringle maneuver versus no Pringle was examined with two electrode catheters. The livers were harvested, and the volume of each lesion was calculated. There was a linear relationship between the volume of hepatic necrosis and the electrolytic dose in (p <.005) in both the single-electrode-catheter and two-electrode-catheter groups. Comparison between the single- and multiple-electrode groups showed a highly significant difference in the dose response (p <.0000002) when more than one electrode was used. Use of the Pringle maneuver during electrolysis produced larger volumes of hepatic necrosis over all doses when using two electrode catheters. Rates of necrosis were 3.8 cm(3)/100 C for a single electrode catheter, 5.46 cm(3)/100 C for two electrode catheters without Pringle, and 6.17 cm(3)/100 C for electrolysis with two electrode catheters coupled with intermittent Pringle maneuver. Thus, electrolysis was both reliable and predictable in producing hepatic necrosis in a dose-dependent manner. The time delay in achieving tumor ablation via electrolysis can be overcome by using two electrodes combined with the Pringle maneuver to increase the volume of the lesion produced.
Berry
D P
DP
Hepatobiliary Unit, Leicester General Hospital, Leicester, United Kingdom.
Garcea
G
G
Vanderzon
P
P
Slimani
E
E
Chong
C
C
Dennison
A R
AR
Maddern
G J
GJ
D000818:Animals; D004572:Electrolysis / Q000295:instrumentation* / Q000379:methods*; D004867:Equipment Design; D016014:Linear Models; D008099:Liver / Q000473:pathology; D009336:Necrosis; D015203:Reproducibility of Results; D013552:Swine