title: Laparoscopy-Guided Transthoracic Transdiaphragmatic Radiofrequency Ablation for Hepatic Tumors Located Beneath the Diaphragm.
abstract: BACKGROUND
  It is often difficult to perform percutaneous radiofrequency ablation (RFA) for hepatic tumors beneath the diaphragm. Diaphragmatic thermal damage is one of the fatal late complications of percutaneous transdiaphragmatic RFA. Our experience with laparoscopic transthoracic transdiaphragmatic intraoperative RFA (LTTI-RFA) for hepatic tumors beneath the diaphragm is reported.
  
  
  METHODS
  Ten patients who underwent LTTI-RFA from 2009 to 2012 were evaluated. Two cases had concomitant partial hepatectomy, and one underwent RFA for two tumors at the same time. The diagnosis was hepatocellular carcinoma in eight cases and metastatic hepatic tumors in two cases. Nine of eleven tumors were located at segments 7 and 8. Nine tumors were less than 20 mm in diameter. The patients were placed in the half left lateral decubitus position with single-lumen tube intubation. After placement of four abdominal ports, a 12-mm port was inserted in the fourth or fifth intercostal space into the diaphragm. The tumor was ablated by an RFA needle through the port. The routine follow-up consisted of laboratory tests and abdominal imaging every 3-6 months.
  
  
  RESULTS
  The median operation time for only one tumor was 137 minutes (range, 105-187 minutes). The median number of times for ablation was three. Severe postoperative complications (>Clavien-Dindo IIIa) were observed in one case (right upper limb paralysis). The median follow-up period was 35 months (range, 11-43 months). There was no local tumor progression. Recurrent hepatic tumor appearance occurred in other parts of the liver in 6 of the 11 patients.
  
  
  CONCLUSIONS
  Laparoscopic transthoracic transdiaphragmatic RFA is an acceptable procedure with a low rate of local recurrence.
authors: 1 Department of Surgery, Hakodate Central General Hospital , Hokkaido, Japan .|2 Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine , Hokkaido, Japan .
authors: Kimitaka
authors: K
authors: Tanaka
authors: 1 Department of Surgery, Hakodate Central General Hospital , Hokkaido, Japan .
authors: Tetsufumi
authors: T
authors: Kojima
authors: 1 Department of Surgery, Hakodate Central General Hospital , Hokkaido, Japan .
authors: Etsuo
authors: E
authors: Hiraguchi
authors: 1 Department of Surgery, Hakodate Central General Hospital , Hokkaido, Japan .
authors: Hideaki
authors: H
authors: Hashida
authors: 2 Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine , Hokkaido, Japan .
authors: Takehiro
authors: T
authors: Noji
authors: 2 Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine , Hokkaido, Japan .
authors: Satoshi
authors: S
authors: Hirano
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D003964:Diaphragm / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome