title: Placement of a sodium hyaluronate solution onto the liver surface as a supportive procedure for radiofrequency ablation of hepatocellular carcinomas located on the liver surface: a preliminary report.
abstract: OBJECTIVE
  To evaluate safety and efficacy of the placement of sodium hyaluronate solution onto the liver surface as a supportive procedure for radiofrequency (RF) ablation of hepatocellular carcinomas (HCCs) located on the liver surface as a possible alternative to RF ablation via laparoscopic approach or with the creation of artificial ascites.
  
  
  METHODS
  Changes in temperature of a sodium hyaluronate layer placed onto an egg white were measured during coagulation of the egg white by an RF ablation needle. A phase I study was performed to evaluate the safety of intraperitoneal injection of a maximum of 20 mL of sodium hyaluronate solution into humans by observing for the occurrence of intraperitoneal inflammation and adhesion. After these studies, RF ablation with ultrasound-guided injection of sodium hyaluronate onto the liver surface was performed, targeting 28 HCC nodules located on the liver surface. Treatment outcomes and complications of this procedure were investigated.
  
  
  RESULTS
  In the in vitro experiment, the maximum temperature of sodium hyaluronate solution was 41°C during RF ablation. No intraperitoneal inflammation or adhesions were observed after intraperitoneal injection of sodium hyaluronate in the phase I study. HCC was completely ablated with sufficient margins after one session of RF ablation, without any burn injuries to the abdominal wall or adjacent organs. Local recurrence was observed in one of 28 patients (3.6%) during 30.1 months of follow-up.
  
  
  CONCLUSIONS
  RF ablation can be safely and effectively performed on HCCs located close to the liver surface with placement of sodium hyaluronate onto the liver surface, thereby preventing burn injuries to abdominal wall or adjacent organs.
authors.affiliation: Department of Gastroenterology, Ogaki Municipal Hospital, 4-86 Minaminokawa, Ogaki, Gifu 503-8502, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Toyoda
authors.forename: Takashi
authors.initials: T
authors.lastname: Kumada
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Tada
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kaneoka
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Maeda
mesh_terms: D000276:Adjuvants, Immunologic; D000368:Aged; D000369:Aged, 80 and over; D002058:Burns, Electric / Q000209:etiology / Q000517:prevention & control*; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011292:Premedication / Q000379:methods*; D016896:Treatment Outcome; D055675:Viscosupplements / Q000008:administration & dosage
chemical_list: D000276:Adjuvants, Immunologic; D055675:Viscosupplements; D006820:Hyaluronic Acid