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

Authors
 Chang Moo Kang  ;  Heung Kyue Ko  ;  Si Young Song  ;  Kyung Sik Kim  ;  Jin Sub Choi  ;  Woo Jung Lee  ;  Byung Ro Kim 
Citation
 SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol.22(2) : 541, 2008 
Journal Title
 SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES 
ISSN
 0930-2794 
Issue Date
2008
MeSH
Carcinoma, Hepatocellular/surgery* ; Catheter Ablation/methods* ; Diaphragm ; Humans ; Intraoperative Care/methods* ; Laparoscopy* ; Liver Neoplasms/surgery* ; Male ; Middle Aged ; Multimedia ; Thoracoscopy*
Keywords
Hepatocellular Carcinoma ;  Liver Transplantation  ; Radiofrequency Ablation  ; Chest Tube  ; Undergo Liver Transplantation 
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
Full Text
http://link.springer.com/article/10.1007%2Fs00464-007-9410-x
DOI
10.1007/s00464-007-9410-x
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Chang Moo(강창무) ORCID logo https://orcid.org/0000-0002-5382-4658
Ko, Heung Kyu(고흥규)
Kim, Kyung Sik(김경식) ORCID logo https://orcid.org/0000-0001-9498-284X
Kim, Byong Ro(김병로)
Song, Si Young(송시영) ORCID logo https://orcid.org/0000-0002-1417-4314
Lee, Woo Jung(이우정) ORCID logo https://orcid.org/0000-0001-9273-261X
Choi, Jin Sub(최진섭)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/107090
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