From: Proceedings 10th World Congress of Cryosurgery
Hepatic cryosurgery: laparoscopic approach, Part III

November 1998
NN Korpan, G Hochwarter, JV Zharkov F Sellner, VN Chernev Vienna International Institute for Cryosurgery, Vienna, Austria; Department Of Surgery, Austria; Technological Research Company Puls, SMZ-Ost Hospital Vienna, Ukraine; Department of Surgery, Kaiser Franz Josef-hospital, Vienna, Austria; Department of Surgery, Kiev Hospital, Kiev, Ukraine

Background: Many Patients with liver tumors are not amenable to curative resection at the time of presentation. Nevertheless, palliative resection still remains as the treatment of choice in the majority of patients. Hepatic cryosurgery has been shown to be a new therapeutic method for unresectable liverturnors. Aim: Assess the effectiveness of this new technique for treating malignant hepatic tumors - laparoscopic cryosurgery as a minimal invasive approach.

Material and Method. Seventeen patients with documented primary liver cancer (3 patients) and with liver metastases (14 patients) were treated with laparoscopic cryosurgery from October 1995 to March 1998. Hepatic cryodesctruction was performed by a universal high-efficiency cryosurgical system "Cryotronic." Pneumoperitoneurn is established by Veress needle. After the abdomen is fully distended, a 12-mm trocar is inserted through the upper folds of the umbilicus to allow introduction of a laparoscope to examine the peritoneal cavity and to visualize the Ever. The second 12-mm trocar/cannula is inserted subcostal. Then the insulated laparoscopic needle cryoprobe is brought into the tumor mass. The freeze cycle was repeated according to the size and number of lesions.

Results: In our series, good reduction of tumor mass was achieved in all palliative cases with laparoscopic cryosurgery. Resolution of the cryolesion was demonstrated by the post-operative ultrasound and CT scans. The benefit was documented in all patients with liver tumor and multiple liver metastases.

Conclusion: Our results suggest that laparoscopic hepatic cryosurgery with liquid nitrogen is a safe and efficacious means for palliation of malignant liver tumors.


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