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Laparoscopic cryosurgery for hepatic tumors. Experimental observations and a case report
1Department of Surgery, McMaster University, St. Joseph's Hospital, Room G815, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada.
Background:
Hepatic cryosurgery has been shown to be a safe technique that may be well suited to a laparoscopic approach.
Methods:
The technical feasibility and safety of laparoscopic cryosurgery was explored first in a pig model. Thereafter we performed the first successful case of laparoscopic hepatic cryosurgery at our institution.
Results:
In the animal model, we found that it is possible to safely identify, target, and cryoablate specific lesions in the liver. Temperature in the peritoneal cavity remained above 35 degrees C, and pathologic examination of the abdominal wall around the cryoprobe site revealed no damage. We also successfully treated a 62-year-old man with a metastatic colorectal carcinoma deep in the right lobe of the liver with laparoscopic cryosurgery using a transpleural approach.
Conclusion:
We conclude that laparoscopic cryosurgery is feasible for lesions anywhere in the liver. For lesions high on the dome of the liver, a transpleural approach may provide better access.