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Surgical Endoscopy

, Volume 22, Issue 2, pp 541–541 | Cite as

Dual-scope guided (simultaneous thoraco-laparoscopic) transthoracic transdiaphragmatic intraoperative radiofrequency ablation for hepatocellular carcinoma located beneath the diaphragm

  • Chang Moo Kang
  • Heung Kyue Ko
  • Si Young Song
  • Kyung Sik Kim
  • Jin Sub ChoiEmail author
  • Woo Jung Lee
  • Byung Ro Kim
Multimedia Manuscript

Abstract

Background

Among treatment modalities for unresectable hepatocellular carcinoma (HCC), radiofrequency ablation (RFA) is getting popular due to low morbidity and its effectiveness. However, when the tumor is located just under the diaphragm, a percutaneous approach for RFA is often impossible because of the difficulty in visualizing the tumor with conventional ultrasonographic examination.

Method

Simultaneous thoraco-laparoscopic transthoracic transdiaphragmatic intraoperative RFA was performed on a 55 year-old male with HCC just beneath the diaphragm as well as laparoscopic RFA for dysplastic nodule near the gallbladder. Most of all, the patient wanted to undergo liver transplantation for the HCC and underlying liver cirrhosis. Therefore we chose to provide this procedure as a bridge to the liver transplantation. A total of four trocars (12 mm, 10 mm, 5 mm trocars for laparoscopy, and one 5 mm trocar for thoracoscopy), a 10 mm flexible laparoscope, a 5 mm thoracoscpe, and a laparoscopic ultrasound were used for this surgical procedure. After finishing laparoscopic RFA for dysplastic nodule near the gallbladder, the patient was placed into the left lateral decubitus for dual-scope guided transthoracic transdiaphragmatic intraoperative RFA. Complete separation of the diaphragm from the hepatic dome and good visualization of the subdiaphragmatic vessels provided a safe procedure without any injury to the diaphragm and other vessels.

Results

The operative time was 240 minutes and the blood loss was zero. The postoperative course was uneventful. The diet was started on the operative day. A chest tube and an abdominal drain was removed on first day after surgery. The patient discharged on the second day after surgery. The patient has been followed up for three months after the dual-scope guided intraoperative RFA without any evidence of tumor recurrence. He is now actively being evaluated for liver transplantation.

Conclusion

Dual-scope guided (simultaneous thoraco-laparoscopic) transthoracic transdiaphragmatic intraoperative RFA is an easy, safe, and effective minimal invasive modality for treatment of the selective patient with HCC, with liver cirrhosis, which is located immediately under the diaphragm. Further experiences and a long term follow up is mandatory.

Keywords

Hepatocellular Carcinoma Liver Transplantation Radiofrequency Ablation Chest Tube Undergo Liver Transplantation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Supplementary material

References

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Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Chang Moo Kang
    • 1
  • Heung Kyue Ko
    • 2
  • Si Young Song
    • 3
  • Kyung Sik Kim
    • 1
  • Jin Sub Choi
    • 1
    Email author
  • Woo Jung Lee
    • 1
  • Byung Ro Kim
    • 1
  1. 1.Department of SurgeryYonsei University College of MedicineSeoudaemun-guKorea
  2. 2.Department of RadiologyYonsei University College of MedicineSeoudaemun-guKorea
  3. 3.Department of Internal MedicineYonsei University College of MedicineSeoudaemun-guKorea

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