Abstract
Background: Radiofrequency ablation (RFA) is gaining widespread acceptance as a safe and effective method for liver tumor ablation. Complete tumor ablation is essential for the success of the procedure. Multiple modalities have been explored in an effort to increase the size of the lesion created by RFA. The purpose of this study was to determine the physiologic effects of the pneumoperitoneum on RFA lesion size. Methods: A total of 32 RFA lesions were created in eight pigs. After the induction of anesthesia, pneumoperitoneums of 2, 12, and 24 mmHg were established sequentially in each animal. After an equilibration period of 2 min, RF was administered with a constant saline-infused (0.9%) needle at 25 W for 3 min. In subsequent and complementary experiments, both before and during RF administration at each intraperitoneal pressure (IPP), Doppler flow was measured by laparoscopic ultrasound in the portal vein and hepatic artery while blood pressure was monitored by a femoral arterial line. The animals were then killed humanely and the livers were harvested. Measurements were taken in three dimensions of the ablated areas, and the volume was calculated. Statistical analyses were performed using analysis of variance (ANOVA) and repeated measures test. Results: The average volumes of the lesions (in cm3) were 3.1 ± 1.8, 5.2 ± 1.7, and 6.7 ± 3.3 for IPP of 2, 12 and 24 mmHg, respectively; there was a significant difference between the area of lesion at an IPP of 2 mmHg and an IPP of 24 mmHg (p < 0.05). Blood flow in the portal vein also decreased significantly from 1.8 ± 0.6, 0.98 ± 0.5, and 0.43 ± 0.2 at IPP of 2, 12, and 24 mmHg, respectively (p < 0.001). Hepatic artery blood flow and peripheral blood pressure did not change significantly in the respective IPP groups. Conclusions: This study indicates that the volume of liver ablated by RF can be increased by augmenting the IPP. Our data support the theory that a decrease in portal blood flow results in decreased heat dissipation during RFA. The laparoscopic approach to RFA offers the advantage of allowing control of the IPP, which may result in a larger volume of ablated tissue per treatment than can be achieved with the percutaneous technique. These preliminary data on normal hepatic tissue must be confirmed clinically in the setting of hepatic tumors.
Similar content being viewed by others
References
AJ Aschoff EM Merkle V Wong Q Zhang M Mendez JL Duerk JS Lewin (2001) ArticleTitleHow does alteration of hepatic blood flow affect liver perfusion and radiofrequency-induced thermal lesion size in rabbit liver? J Magn Reson Imag 13 57–63 Occurrence Handle10.1002/1522-2586(200101)13:1<57::AID-JMRI1009>3.0.CO;2-N Occurrence Handle1:STN:280:DC%2BD3M7nslKjtA%3D%3D
AJ Bilchik TF Wodd D Allegra GJ Tsioulias M Chung M Rose KP Ramming DL Morton (2000) ArticleTitleCryosurgical ablation and radiofrequency ablation for unresectable hepatic malignant neoplasms: a proposed algorithm. Arch Surg 135 657–662 Occurrence Handle10.1001/archsurg.135.6.657 Occurrence Handle1:STN:280:DC%2BD3czgtVentQ%3D%3D Occurrence Handle10843361
SB Chinn FT Lee Jr GD Kennedy C Chinn CD Johnson TC III Winter TF Warner DM Mahvi (2001) ArticleTitleEffect of vascular occlusion on radiofrequency ablation of the liver: results in a porcine model. AJR Am J Roentgenol 176 789–795
SA Curley F Izzo P Delrio LM Ellis J Granchi P Vallone F Fiore S Pignata B Daniele F Cremona (1999) ArticleTitleRadiofrequency ablation of unresectable primary and metastatic hepatic malignancies: results in 123 patients. Ann Surg 230 1–8 Occurrence Handle10.1097/00000658-199907000-00001 Occurrence Handle1:STN:280:DyaK1MzisFKitA%3D%3D Occurrence Handle10400029
T de Baere A Denys B Johns Wood N Lassau M Kardache V Vilgrain Y Menu A Roche (2001) ArticleTitleRadiofrequency liver ablation: experimental comparative study of water-cooled versus expandable systems. AJR Am J Roentgenol 176 187–192 Occurrence Handle11133564
SN Goldberg PF Hahn KK Tanabe PR Mueller W Schima CA Athanasoulis CC Compton L Solbiati GS Gazelle (1998) ArticleTitlePercutaneous radiofrequency tissue ablation: does perfusion-mediated tissue cooling limit coagulation necrosis? J Vasc Interv Radiol 9 101–111 Occurrence Handle9468403
O Goletti R Lencioni N Armillotta A Puglisi PV Lippolis L Lorenzetti D Cioni B Musco C Bartolozzi E Cavina (2000) ArticleTitleLaparoscopic radiofrequency thermal ablation of hepatocarcinoma: preliminary experience. Surg Laparosc Endosc Percutan Tech 10 284–290 Occurrence Handle10.1097/00019509-200010000-00005 Occurrence Handle1:STN:280:DC%2BD3M7gtFGhsA%3D%3D Occurrence Handle11083210
PD Hansen S Rogers CL Corless LL Swanstrom AE Siperstein (1999) ArticleTitleRadiofrequency ablation lesions in a pig liver model. J Surg Res 87 114–121
Y Hashikura S Kawasaki Y Munakata S Hashimoto K Hayashi M Makuuchi (1994) ArticleTitleEffects of peritoneal insufflation on hepatic and renal blood flow. Surg Endosc 8 759–761 Occurrence Handle1:STN:280:ByqD28vktVw%3D Occurrence Handle7974101
J Jakimowicz G Stultiens F Smulders (1998) ArticleTitleLaparoscopic insufflation of the abdomen reduces portal venous flow. Surg Endosc 12 129–132 Occurrence Handle10.1007/s004649900612 Occurrence Handle1:STN:280:DyaK1c7ktVemsQ%3D%3D Occurrence Handle9479726
LR Jiao PD Hansen R Havilk RR Mitry M Pignatelli N Habib (1999) ArticleTitleClinical short-term results of radiofrequency ablation in primary and secondary liver tumors. Am J Surg 177 303–306 Occurrence Handle10.1016/S0002-9610(99)00043-4 Occurrence Handle1:STN:280:DyaK1M3ls1Orsg%3D%3D Occurrence Handle10326848
TG John JD Greig JL Crosbie WFA Miles OJ Garden (1994) ArticleTitleSuperior staging of liver tumors with laparoscopy and laparoscopic ultrasound. Ann Surg 220 711–719 Occurrence Handle1:STN:280:ByqD2sjkslQ%3D Occurrence Handle7986136
MC Kolios MD Sherar JW Hunt (1995) ArticleTitleLarge blood vessel cooling in heated tissues: a numerical study. Phys Med Biol 40 477–494 Occurrence Handle10.1088/0031-9155/40/4/001 Occurrence Handle1:STN:280:ByqA3svktl0%3D Occurrence Handle7610110
EJ Patterson CH Scudamore DA Owen AG Nagy AJ Buczkowski (1998) ArticleTitleRadiofrequency ablation of porcine liver in vivo: effects of blood flow and treatment time on lesion size. Ann Surg 227 559–565 Occurrence Handle1:STN:280:DyaK1c3itlSisg%3D%3D Occurrence Handle9563546
S Rossi F Garbagnati ID De Francesco F Accollea L Leonardi P Quaretti A Zangrandi C Paties R Lencioni (1999) ArticleTitleRelationship between the size and shape of radiofrequency-induced thermal lesions and hepatic vascularization. Tumori 85 137–141 Occurrence Handle10363082
DJ Scott WN Young LM Watumull G Lindberg JB Fleming JF Huth RV Rege DR Jeyarajah DB Jones (2001) ArticleTitleAccuracy and effectiveness of laparoscopic vs open hepatic radiofrequency ablation. Surg Endosc 15 135–140 Occurrence Handle10.1007/s004640080066 Occurrence Handle1:STN:280:DC%2BD3Mvit1Ghtw%3D%3D Occurrence Handle11285955
T Shibata T Niinobu N Ogata (2000) ArticleTitleComparison of the effects of in-vivo thermal ablation of pig liver by microwave and radiofrequency ablation. J Hepatobil Pancreat Surg 7 592–598 Occurrence Handle10.1007/s005340070009 Occurrence Handle1:STN:280:DC%2BD3M3gtFektA%3D%3D
A Siperstein A Garland K Engle S Rogers E Berber A Foroutani A String T Ryan P Ituarte (2000) ArticleTitleLocal recurrence after laparoscopic radiofrequency thermal ablation of hepatic tumors. Ann Surg Oncol 7 l06–113
A Siperstein A Garland K Engle S Rogers E Berber A String A Foroutani T Ryan (2000) ArticleTitleLaparoscopic radiofrequency ablation of primary and metastatic liver tumors: technical considerations. Surg Endosc 14 400–405
TF Wood DM Rose M Chung DP Allegra LJ Foshag AJ Bilchik (2000) ArticleTitleRadiofrequency ablation of 231 unresectable hepatic tumors: indications, limitations, and complications. Ann Surg Oncol 7 593–600 Occurrence Handle1:STN:280:DC%2BD3cvltVGktg%3D%3D Occurrence Handle11005558
Acknowledgements
Berchtold GmbH & Co, Tuttlingen, Germany, provided equipment for this study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Smith, M., Mutter, D., Forbes, L. et al. The physiologic effect of the pneumoperitoneum on radiofrequency ablation . Surg Endosc 18, 35–38 (2004). https://doi.org/10.1007/s00464-001-8235-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-001-8235-2