Laparoskopische radio-frequenzablation von primären und sekundären lebertumoren

Radiofrequency-ablation is an effective therapeutic option for destruction of irresectable primary and secondary liver tumors. Application of the electrodes occurs transcutaneously using sonographic or computertomographic guidance or operative by laparotomy or laparoscopy. Supporter of open techniques argue with the wellknown limitations of preoperative diagnostics regarding detection of small liver tumors and peritoneal carcinosis. The laparoscopic approach combines minimal invasiveness and optimal diagnosis. Patients and Methods: Between 2/2001 and 12/2004 9 patients with irresectable liver tumors were treated with laparoscopic radiofrequency-ablation. A laparoscopic RFA was performed in patients with contraindications for laparotomy, superficial lesions adjacent to neighbouring organs, deep-sited lesions with a very difficult percutaneous approach and in combination with other laparoscopic operations. Results: All intrahepatic tumors could be detected safely. Additional liver tumors were identified in 3 (33%) of 9 patients by laparoscopic intraoperative ultrasound. All 22 tumors of the 9 patients could be ablated completely, whereas free-hand punction was performed for 10 tumors and the use of a laparoscopic ultrasound probe with a punction canal was carried out in 12 tumors. Intraoperatively there were no RFA related complications and postoperatively one patient developed a secondary bleeding. Discussion: Laparoscopic radiofrequency-ablation is safely practicable and offers a combination of minimal invasiveness and the advantages of laparotomy. Therefore it offers the possibility of simultaneous inflow-occlusion during thermoablation, the protection of neighboring organs and the enlargement of the diagnostic by intraoperative ultrasound and diagnostic laparoscopy for exclusion of peritoneal cardnosis. For the application of the RFA-Probe the optional use of a free-hand punction or a laparoscopic ultrasound probe with a punction canal dependent on the location of the tumor is possible.