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[2]
Figure 1: The Barcelona-Clinic Liver Cancer staging system for hepatocellular carcinoma (from Bruix et al . ). PS: performance status; M: metastasis classifi cation;
N: node classifi cation; Bb: bilirubin; LT: liver transplantation; RFA: radiofrequency ablation; TACE: transarterial chemoembolization
that intra-operative laparoscopic ultrasound (IOLUS) permits suitable for liver resection in whom perRFA was contraindicated
detection of 25% of new HCC nodules and allows much for the following reasons: (1) lesions in proximity to the
[11]
more accurate staging. [8] viscera; (2) subcapsular lesions with a high risk of tumoral
seeding; (3) lesions not visible by perRFA; and selected patients
In this paper, we present our experience in laparoscopic RFA, as a bridging therapy in order to meet the Milan criteria.
analyzing the outcomes to show the safety and utility of this
technique as a valid therapeutic alternative in the selected The follow-up period of each patient was recorded as the
patients with HCC. time from the surgical procedure until last clinical evaluation,
loss to follow-up or death.
METHODS

Post-operative complications were recorded and classified by
Patients and methods the modified Clavien-Dindo Classification System. [12]
Between March 2009 and December 2014, all patients
with HCC attended at the Hospital Son Llàtzer in Palma de Surgical procedures
Mallorca were entered in a prospective database. A complete Procedures were performed with the patient under general
medical report was obtained in each patient. Age, gender, anesthesia and in the supine position. The pneumoperitoneum
etiology, patient characteristics such as comorbidities was performed with insufflation of CO through a Veress
and liver function, size and location of the tumors, main needle inserted through a small 2-3 cm incision above the
2
and associated procedures, post-operative complications,
treatment effectiveness and long-term results were recorded. umbilicus. Patients with nodules in segments VI and VII
In all, 149 patients were included in the database, with a were positioned in left decubitis position and an 11-mm
mean of 24.83 new cases/year. Thirty-seven percent of the port was placed in the anterior axillary line. In all cases, the
patients were suitable for curative treatments such as liver abdominal pressure was maintained under 12 mmHg. In our
transplantation (which is not performed in our center), liver procedures we used a 30° camera (Karl Storz GrubH and Co
resection, alcoholization, and radiofrequency. The study was KG, Tuttlingen, Germany) and a first complete inspection of
approved by review board of Hospital Son Llàtzer. the intraperitoneal organs were performed to rule out any
extrahepatic disease. A second 5-mm trocar was placed in the
A retrospective study was carried out of patients undergoing epigastric area on the left side of the falciform ligament to
laparoscopic RFA for HCC. The procedure was performed in: introduce the ultrasound device. When lesions were located
patients with a single lesion or a maximum of three lesions in the upper part of segment VIII, a hole was made through
smaller than 5 cm who, due to medical problems or their age, the falciform ligament in order to provide better access for
were not candidates for liver transplantation; patients not the ultrasound transducer. Usually an auxiliary 5-mm trocar

Hepatoma Research | Volume 1 | Issue 2 | July 15, 2015 87