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Tammaro V, Carlomagno N, Santangelo M, Calogero A, Dodaro CA, Vernillo A, Sica A, Peluso G, Campanile S, Sagnelli E, Sagnelli C. One-stage resection of primary colorectal cancer and hepatic metastases using the Habib Device: analysis of 40 consecutive cases treated in a Unit of general surgery. Minerva Med 2022; 113:846-852. [PMID: 32407049 DOI: 10.23736/s0026-4806.20.06613-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND More than 50% of patients with colorectal cancer (CRC) present or develop hepatic metastases (HM). The intraoperative use of the Habib 4X® radio frequency probe device is safe in resetting HM and allows a one-stage resection of both CRC and HM with a similar mortality rate than a two-stage surgical treatment. METHODS After an exhaustive residential training at the reference center for hepato-biliary surgery of the Imperial College of London, we treated at our unit of general surgery 40 consecutive patients with CRC and HM with the one-stage resection, using the Habib 4X® intraoperative radiofrequency probe device to reset HM. RESULTS None of the 40 patients died during the intra-operatory and post-operatory periods, none presented liver failures during the postoperative course nor complication related to the Habib's resection procedure (e.g. bleeding, abscess, bile leak). The amount of intra-operative liver bleeding was minimal. New HM arose in 10 (25%) cases, with a mean disease-free interval of 13 months, but the hepatic tissue close to previous resections remained cancer-free. The 69.7% of patients were disease-free at month 24 of the post-operative follow-up and 5-year rate was about 70%. CONCLUSIONS The data suggest that surgeons well trained at a reference center for hepato-biliary surgery may perform with excellent results the one-stage CRC and HM resection with the Habib 4X® device even in a Unit of general surgery.
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Affiliation(s)
- Vincenzo Tammaro
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy -
| | - Nicola Carlomagno
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Michele Santangelo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Armando Calogero
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Concetta A Dodaro
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Antonio Vernillo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Antonello Sica
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Gaia Peluso
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Silvia Campanile
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Evangelista Sagnelli
- Department of Mental Health and Public Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Caterina Sagnelli
- Department of Mental Health and Public Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
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Vavra P, Karnik L, Skrobankova M, Jurcikova J, Ihnat P, Zonca P, Peteja M, El-Gendi A, Czudek S. Advancement in liver laparoscopic resection - development of a new surgical device. ACTA ACUST UNITED AC 2018. [PMID: 29513788 PMCID: PMC5856430 DOI: 10.1590/1414-431x20176062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Liver resection is the standard treatment for any liver lesion. Laparoscopic liver
resection is associated with lower intra-operative blood loss and fewer complications
than open resection. Access to the posterior part of the right liver lobe is very
uncomfortable and difficult for surgeons due the anatomic position, especially when
employing laparoscopic surgery. Based on these experiences, a new laparoscopic device
was developed that is capable of bending its long axis and allowing the application
of radiofrequency energy in areas that were not technically accessible. The device is
equipped with four telescopic needle electrodes that cause tissue coagulation after
the delivery of radiofrequency energy. Ex vivo testing was performed
in 2012 and 2014 at the University Hospital, Ostrava, on a porcine liver tissue. The
main goal of this testing was to verify if the newly proposed electrode layout was
suitable for sufficient tissue coagulation and creating a safety zone around lesions.
During the ex vivo testing, the material of needle electrodes was
improved to achieve the lowest possibility of adhesion. The power supply was adjusted
from 20 to 120 W and the ablation time, which varied from 10 to 110 s, was monitored.
Subsequently, optimal power delivery and time for coagulation was determined. This
experimental study demonstrated the feasibility and safety of the newly developed
device. Based on the ex vivo testing, LARA-K1 can create a safety
zone of coagulation. For further assessment of the new device, an in
vivo study should be performed.
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Affiliation(s)
- P Vavra
- Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Department of Surgery, University Hospital Ostrava, Ostrava, Czech Republic.,Department of Cybernetics and Biomedical Engineering, Faculty of Electrical Engineering and Computer Science, VSB-Technical University of Ostrava, Ostrava, Czech Republic
| | - L Karnik
- Department of Robotic, Faculty of Mechanical Engineering, VSB-Technical University of Ostrava, Ostrava, Czech Republic
| | - M Skrobankova
- Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Department of Internal Medicine, University Hospital of Ostrava, Ostrava, Czech Republic
| | - J Jurcikova
- Department of Vice-President for Science and Research, University Hospital Ostrava, Ostrava, Czech Republic
| | - P Ihnat
- Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Department of Surgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - P Zonca
- Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Department of Surgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - M Peteja
- Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Department of Surgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - A El-Gendi
- Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - S Czudek
- Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Department of Surgery, University Hospital Ostrava, Ostrava, Czech Republic
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New semi-spherical radiofrequency energy device for liver resection: an experimental study in pigs. ACTA VET BRNO 2015. [DOI: 10.2754/avb201584040397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this experimental study was to verify a new semi-spherical surgical tool for bipolar radiofrequency liver ablation, which can solve some of the disadvantages of the commonly used device, such as the long duration of ablation. A total of 12 pigs which were randomly divided into two groups were used. Each pig underwent resection of the two liver lobes. In group 1, pigs were treated with the commonly used device; in group 2 the newly developed semi-spherical device was used. During surgery and the post-surgical period, many categories were observed and later analyzed. The blood count and biochemistry were monitored on days 0, 14 and 30 from the operation. On day 14 since the liver resection, pigs underwent diagnostic laparoscopy to evaluate their condition focusing on the site of the liver lobe resection. On day 30 after operation, all pigs were euthanized and subjected to histopathological examination. Histopathological evaluation of thermal changes at the resection margin showed strong thermal alteration in both groups. Data between both groups were compared using median test for continuous variables and Fisher’s exact test for categorical variables. Statistical analyses were performed with IBM SPSS software version 18.0. Statistical analysis of collected data did not prove any significant (P < 0.05) differences between the commonly used device and the newly designed surgical tool.
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Niu H, Zhang X, Wang B, Zhou Z, Wang J, Yang X, Du T. The clinical utility of RFA in esophageal and cardia cancer patients with severe malignant obstruction. Tumour Biol 2015; 37:1337-40. [PMID: 26293899 DOI: 10.1007/s13277-015-3925-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 08/11/2015] [Indexed: 12/29/2022] Open
Abstract
Malignant obstruction of esophageal and cardia cancer greatly affects the prognosis and life quality of patients. However, no better regimens have been reported up to now. In recent years, radiofrequency ablation (RFA) has been prospectively proven in the management of some tumors. So, we investigated the impact of RFA on the malignant obstruction of esophageal and cardia cancer. In this study, we evaluated the operation duration, ablation duration, immediate compilations, etc., and followed up for 12 months. Our findings showed that there existed no technical problems in all 22 patients with a mean operation duration of 58 min and mean ablation duration of 23 min. No complication was observed in addition to postoperative low pressure in one patient and retrostenal pain in another patient. Importantly, all 22 patients obtained complete remission with normal diet and felt no sense of obstruction. Mean hospitalization time was 3 days and then the 12-month follow-up continued. To our relief, re-obstruction was not observed in all patients for 2 months. In conclusion, the entire effect of RFA was satisfactory, and patients can obtain a better life quality, less pains, and complications. So RFA should be advocated and greatly investigated by more institutes and hospitals.
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Affiliation(s)
- Hongxin Niu
- Department of Minimally Invasive Surgery, Affiliated Hospital of Shandong Academy of Medical Sciences, 38# Wuyingshan Road, Jinan, 250031, People's Republic of China
| | - Xikun Zhang
- Department of Minimally Invasive Surgery, Affiliated Hospital of Shandong Academy of Medical Sciences, 38# Wuyingshan Road, Jinan, 250031, People's Republic of China
| | - Bin Wang
- Department of Minimally Invasive Surgery, Affiliated Hospital of Shandong Academy of Medical Sciences, 38# Wuyingshan Road, Jinan, 250031, People's Republic of China
| | - Zhao Zhou
- Department of Minimally Invasive Surgery, Affiliated Hospital of Shandong Academy of Medical Sciences, 38# Wuyingshan Road, Jinan, 250031, People's Republic of China
| | - Jian Wang
- Department of Minimally Invasive Surgery, Affiliated Hospital of Shandong Academy of Medical Sciences, 38# Wuyingshan Road, Jinan, 250031, People's Republic of China
| | - Xiangshan Yang
- Department of Pathology, Affiliated Hospital of Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Tong Du
- Department of Minimally Invasive Surgery, Affiliated Hospital of Shandong Academy of Medical Sciences, 38# Wuyingshan Road, Jinan, 250031, People's Republic of China.
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Mulier S, Jiang Y, Jamart J, Wang C, Feng Y, Marchal G, Michel L, Ni Y. Bipolar radiofrequency ablation with 2 × 2 electrodes as a building block for matrix radiofrequency ablation:Ex vivoliver experiments and finite element method modelling. Int J Hyperthermia 2015; 31:649-65. [DOI: 10.3109/02656736.2015.1046194] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Colorectal cancer liver metastases: laparoscopic and open radiofrequency-assisted surgery. Wideochir Inne Tech Maloinwazyjne 2015; 10:205-12. [PMID: 26240620 PMCID: PMC4520843 DOI: 10.5114/wiitm.2015.52082] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/24/2015] [Accepted: 03/22/2015] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION The liver is the most common site of colorectal metastases (colorectal liver metastases - CLM). Surgical treatment in combination with oncological therapy is the only potentially curative method. Unfortunately, only 10-25% of patients are suitable for surgery. Traditionally, open liver resection (OLR) is usually performed. However, laparoscopic liver resection (LLR) has become popular worldwide in the last two decades. AIM To evaluate the effectiveness and benefits of radiofrequency minor LLR of CLM in comparison with OLR. MATERIAL AND METHODS The indication for surgery was CLM and the possibility to perform minor laparoscopic or OLR not exceeding two hepatic segments according to Couinaud's classification. RESULTS Sixty-six minor liver resections for CLM were performed. Twenty-five (37.9%) patients underwent a laparoscopic approach and 41 (62.1%) patients underwent OLR. The mean operative time was 166.4 min for LLR and 166.8 min for OLR. Average blood loss was 132.3 ±218.0 ml during LLR and 149.5 ±277.5 ml during OLR. Length of hospital stay was 8.4 ±2.0 days for LLR and 10.5 ±5.8 days for OLR. All resections were R0. There was no case of mortality. Postoperative complications were recognized in 9 (13.6%) patients: 8 in the group of OLR patients and 1 in the LLR group. The median survival time for LLR was 70.5 months and for OLR 61.9 months. The 5-year overall survival rate was higher for LLR vs. OLR - 82.1% vs. 69.8%. The average length of disease-free interval after LLR was greater (52.2 months) in comparison with OLR (49.4%). The 5-year disease-free interval was 63.2% for LLR and 58% for OLR. CONCLUSIONS Outcomes and oncological radicality of minor laparoscopic liver resections of CLM are comparable to outcomes of OLR.
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Technical development of a new semispherical radiofrequency bipolar device (RONJA): ex vivo and in vivo studies. BIOMED RESEARCH INTERNATIONAL 2014; 2014:532792. [PMID: 24812620 PMCID: PMC4000950 DOI: 10.1155/2014/532792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 03/04/2014] [Indexed: 12/28/2022]
Abstract
The aim of this study is to inform about the development of a new semispherical surgical instrument for the bipolar multielectrode radiofrequency liver ablation. Present tools are universal; however they have several disadvantages such as ablation of healthy tissue, numerous needle punctures, and, therefore, longer operating procedure. Our newly designed and tested semispherical surgical tool can solve some of these disadvantages. By conducting an in vivo study on a set of 12 pigs, randomly divided into two groups, we have compared efficiency of the newly developed instrument with the commonly used device. Statistical analysis showed that there were no significant differences between the groups. On average, the tested instrument RONJA had shorter ablation time in both liver lobes and reduced the total operating time. The depth of the thermal alteration was on average 4 mm larger using the newly tested instrument. The new radiofrequency method described in this study could be used in open liver surgery for the treatment of small liver malignancies (up to 2 cm) in a single application with the aim of saving healthy liver parenchyma. Further experimental studies are needed to confirm these results before clinical application of the method in the treatment of human liver malignancies.
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Itoi T, Isayama H, Sofuni A, Itokawa F, Tamura M, Watanabe Y, Moriyasu F, Kahaleh M, Habib N, Nagao T, Yokoyama T, Kasuya K, Kawakami H. Evaluation of effects of a novel endoscopically applied radiofrequency ablation biliary catheter using an ex-vivo pig liver. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2011; 19:543-7. [DOI: 10.1007/s00534-011-0465-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Takao Itoi
- Department of Gastroenterology and Hepatology; Tokyo Medical University; 6-7-1 Nishishinjuku, Shinjuku-ku Tokyo 160-0023 Japan
| | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Atsushi Sofuni
- Department of Gastroenterology and Hepatology; Tokyo Medical University; 6-7-1 Nishishinjuku, Shinjuku-ku Tokyo 160-0023 Japan
| | - Fumihide Itokawa
- Department of Gastroenterology and Hepatology; Tokyo Medical University; 6-7-1 Nishishinjuku, Shinjuku-ku Tokyo 160-0023 Japan
| | | | | | - Fuminori Moriyasu
- Department of Gastroenterology and Hepatology; Tokyo Medical University; 6-7-1 Nishishinjuku, Shinjuku-ku Tokyo 160-0023 Japan
| | - Michel Kahaleh
- Department of Gastroenterology; Well Cornell Medical Center; New York NY USA
| | - Nagy Habib
- Department of Surgery and Cancer; Imperial College London; London UK
| | - Toshitaka Nagao
- Department of Pathology; Tokyo Medical University; Tokyo Japan
| | - Tomohisa Yokoyama
- Department of Clinical Oncology; Tokyo Medical University; Tokyo Japan
| | - Kazuhiko Kasuya
- Third Department of Surgery; Tokyo Medical University; Tokyo Japan
| | - Hiroshi Kawakami
- Department of Gastroenterology; Hokkaido University Graduate School of Medicine; Sapporo Japan
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