Liver tissue dissection: ultrasonic or RFA energy?
BACKGROUND
Hepatic resection is the only potential curative treatment for a wide variety of conditions. However, liver surgery is technically demanding and closely associated with a number of serious complications. New devices and techniques are currently being applied in practice, which will improve the surgical outcome.


METHODS
This retrospective study compares two methods of liver parenchymal division: ultrasound energy, a modern but already widely used technique, and radio-frequency ablation (RFA), a completely novel method. The parameters investigated include the amount of blood transfused, the necessity of the Pringle maneuver, the length of time required for parenchymal division, and postoperative morbidity and mortality. The patients were divided into two groups. In one group (Group A), 15 patients underwent 17 ultrasound-assisted liver resections, in which ten metastatic tumors, six hepatomas, and one cholangiocarcinoma were resected. In Group B, 21 patients underwent 22 RFA-assisted hepatectomies in which 11 metastatic tumors, ten hepatomas, and two cholangiocarcinomas were removed.


RESULTS
Thirteen patients (87%) in Group A and 11 (52%) in Group B received a transfusion, with an average of 3.5 and 1.6 units of red blood cells, respectively. The Pringle maneuver was necessary in two cases in Group A but was unnecessary in Group B. The mean length of time required for parenchymal dissection was 124 min in Group A and 93.18 min in Group B. One (6.7%) and four (19%) complications were observed in Group A and B, respectively (statistically not significant). Mortality remained zero in both groups.


CONCLUSIONS
RFA energy provides a novel reliable and safe alternative that can be used exclusively or as a supplement to the older techniques. Both resection time and amount of blood transfusion were reduced in the RFA group.
Felekouras
Evangelos
E
First Department of Surgery, University of Athens, Laiko General Hospital, Athens, Greece.
Prassas
Evangelos
E
Kontos
Michael
M
Papaconstantinou
Ioannis
I
Pikoulis
Emmanouil
E
Giannopoulos
Athanasios
A
Tsigris
Christos
C
Tzivras
Michael
M
Bakogiannis
Chris
C
Safioleas
Michael
M
Papalambros
Efstathios
E
Bastounis
Elias
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014464:Ultrasonic Therapy