title: Laparoscopic liver packing to protect surrounding organs during thermal ablation.
abstract: OBJECTIVE
  To evaluate the feasibility of liver packing for the prevention of injury to adjacent organs during thermal ablation of liver tumors.
  
  
  METHODS
  Between January 2005 and March 2010, 47 (52 sessions) patients with non-resectable liver tumors were treated and their tumors (55 primary carcinomas and 65 metastases, 1-12) were isolated from adjacent organs by laparoscopic liver mobilization and packing. Stereotactic radiofrequency ablation (SRFA) comprised body fixation, contrast-enhanced CT, 3-D planning, navigation, needle placement, control CT of needle positions (with image fusion), thermal ablation and control CT (with image fusion). Liver packing was removed laparoscopically thereafter. Complications, primary success and local recurrence rates were analyzed.
  
  
  RESULTS
  A total of 120 liver lesions with a median size of 2.4 cm (range 1-15 cm) were treated. Laparoscopic packing could be performed in all patients. The primary success rate of ablation was 91.6% (110/120) and the local recurrence rate was 4.5% (5/110). There was one perioperative death (1.9%). All remaining complications could be managed by radiological interventions. Despite broad surface contact thermal injury of surrounding organs could be prevented in all patients.
  
  
  CONCLUSIONS
  Liver packing presents a viable and safe option for RFA of tumors with broad surface contact to surrounding organs with excellent local tumor control.
authors.affiliation: Section of Microinvasive Therapy, Department of Radiology, Medical University of Innsbruck , Innsbruck , Austria.
authors.forename: Peter
authors.initials: P
authors.lastname: Schullian
authors.forename: Helmut
authors.initials: H
authors.lastname: Weiss
authors.forename: Alexander
authors.initials: A
authors.lastname: Klaus
authors.forename: Gerlig
authors.initials: G
authors.lastname: Widmann
authors.forename: Christof
authors.initials: C
authors.lastname: Kranewitter
authors.forename: Christof
authors.initials: C
authors.lastname: Mittermair
authors.forename: Raimund
authors.initials: R
authors.lastname: Margreiter
authors.forename: Reto
authors.initials: R
authors.lastname: Bale
mesh_terms: D000328:Adult; D000368:Aged; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D013238:Stereotaxic Techniques; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
keywords: Stereotaxy; interventional radiology; liver packing; liver tumor; radiofrequency ablation