BACKGROUND
Radiofrequency (RF) generated heat has been successfully used to ablate liver tumours.1 Recently, a new technique for liver resection using RF energy has been developed2 with minimal morbidity and maximum liver parenchyma preservation. We present a technical modification on pericystectomy for liver hydatid disease using RF.
TECHNIQUE
Six selected patients diagnosed with peripherally located hydatid cyst, underwent RF-assisted pericystectomy under intra-operative ultrasound guidance.3 The Cool tip RF probe (3 cm; Radionics Europe/TycoHealthcare, Koningin Elisabethlaan 45, B-900, Gent, Belgium; info@radionics.be) is connected to a 500-kHz generator (Model RFG-3D). Using the manual mode, the probe is applied until the impedance of the coagulated tissue reaches a level twice as high as the initial measurement. It takes a few seconds to create a ‘zone of dessication’. Division of the surrounding parenchyma using a scalpel was then performed starting from the liver surface and advancing deeper. In that way, vascular and biliary structures can be identified. Care is taken to leave behind the least possible coagulated liver tissue (Fig. 1). In four cases the cyst was removed en bloc (closed pericystectomy). In two cases, the cyst was evacuated first followed by the removal of the pericyst.(open pericystectomy; Fig. 2).
Figure 1.
The liver surface after radiofrequency-assisted closed pericystectomy.
Figure 2.
Excision of the pericyst using radiofrequency-assisted (open pericystectomy).
DISCUSSION
Blood loss was minimal and one biliary leak was treated conservatively. Various techniques and instrumentation have been developed for liver resections. However, there is lack of prospective studies comparing these techniques. RF-assisted pericystectomy seems to be a safe and simple alternative in selected patients with cysts located away from the liver hilum. Larger number of patients can define better the role of this promising technique.
References
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