title: Ultrasound-guided radiofrequency ablation of the segmental Glissonian pedicle: A new technique for anatomic liver resection.
abstract: BACKGROUND
  Anatomic liver resection is widely accepted as the optimal surgical treatment for hepatocellular carcinoma (HCC); however, the complexity of conventional operative methods limits their use. To explore the possibility of using modern techniques to achieve a simpler approach, we have evaluated ultrasound-guided segmental radiofrequency ablation (RFA) of the Glissonian pedicle before liver resection in a porcine model and in HCC patients.
  
  
  METHODS
  This study had 2 stages. First, we piloted anatomic liver resection using ultrasound-guided RFA of the segmental Glissonian pedicle in 6 Bama miniature pigs. Having found this technique safe and effective, we selected 21 HCC patients to treat with the same approach.
  
  
  RESULTS
  The pigs had no postoperative mortality or morbidity. Demarcation areas were apparent in all targeted segments. The mean length of segmental portal, arterial, and biliary tract branches ablated was 1.7, 1.4, and 1.6 cm, respectively. Human HCC operations consisted of 8 subsegmentectomies, 8 segmentectomies, and 5 multisegmentectomies. The procedure was feasible in all patients, with no mortality, morbidity, or need for blood transfusions. A demarcation area was apparent in all patients within 157 seconds of RF application for each target feeding vessel. The mean number of target feeding vessels was 2 (range, 1-7).
  
  
  CONCLUSIONS
  Our study demonstrates that ultrasound-guided RFA ablation of the segmental Glissonian pedicle is expedient, safe, and effective, and is suitable for resection of any hepatic segments or subsegments, from segments 2 to 8.
authors.affiliation: Hospital and Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Chinese PLA Postgraduate Medical School, Beijing, China.
authors.forename: Ji-Ye
authors.initials: JY
authors.lastname: Chen
authors.affiliation: Department of Ultrasound Diagnosis, Chinese PLA General Hospital, Chinese PLA Postgraduate Medical School, Beijing, China.
authors.forename: Yu-Kun
authors.initials: YK
authors.lastname: Luo
authors.affiliation: Hospital and Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Chinese PLA Postgraduate Medical School, Beijing, China.
authors.forename: Shou-Wang
authors.initials: SW
authors.lastname: Cai
authors.affiliation: Hospital and Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Chinese PLA Postgraduate Medical School, Beijing, China.
authors.forename: Wen-Bin
authors.initials: WB
authors.lastname: Ji
authors.affiliation: Department of Surgery, Would Care Clinical Research Program, Veteran Affair Medical Center, Providence, RI.
authors.forename: Min
authors.initials: M
authors.lastname: Yao
authors.affiliation: Hospital and Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Chinese PLA Postgraduate Medical School, Beijing, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Jiang
authors.affiliation: Hospital and Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Chinese PLA Postgraduate Medical School, Beijing, China. Electronic address: dongjh301@163.com.
authors.forename: Jia-Hong
authors.initials: JH
authors.lastname: Dong
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D017115:Catheter Ablation / Q000379:methods* / Q000401:mortality; D002681:China; D004195:Disease Models, Animal; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006498:Hepatectomy / Q000379:methods* / Q000401:mortality / Q000639:trends; D006801:Humans; D008099:Liver / Q000033:anatomy & histology / Q000601:surgery*; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D018570:Risk Assessment; D015996:Survival Rate; D013552:Swine; D013556:Swine, Miniature; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*