[Innovative application of radiofrequency in hepatic surgery. Preliminary experience]

Intraoperative blood loss has long been identified as one of the major morbidity and mortality predictors in liver surgery. A new approach towards achieving bloodless resection is the use of heat coagulative necrosis in healthy liver tissue, creating a zone of necrosis in which resection can be performed with a scalpel. We have used it for a variety of liver resections ranging from wedge resection to trisegmentectomy to establish the best indications. From March 2005 to June 2006 we performed 31 liver resections on 22 consecutive patients using this method. The most common indication was metastatic colorectal cancer (77.2%). We treated a heterogeneous patient series in terms of tumour location and extent of resection. Resectability was enhanced by means of downsizing chemotherapy (2 cases) and induction of portal hypertrophy (1 case). Twelve patients with metastatic colorectal cancer received adjuvant chemotherapy after the primary operation according to histological staging. Metastatic liver disease was synchronous in 7 cases and metachronous in 8 (mean time to metastasis 25.3 months). The operative spectrum ranged from parenchyma-saving atypical resections to extended right hepatectomy. With two exceptions, intraoperative blood loss was lower than 100 ml. Four patients (18.2%) developed surgery-related complications consisting in abscess formation at the resection site. Liver resection using the sealer device would appear to be a safe, time-efficient method, though it requires extensive knowledge of the anatomy of the intrahepatic vessels. Resections in the proximity of hilar structures or large vessels are not indicated for fear of thermal damage. Extended resections are possible if performed with a hybrid technique with conventional hilar preparation. In our experience this new application of radiofrequency-assisted liver resection seems to be effective and safe and may afford a number of advantages (no blood loss, short resection time. etc.) in selected cases.