Physical therapy for acute and sub-acute low back pain: A systematic review and expert consensus

OBJECTIVE

To review the effectiveness of different physical therapies for acute and sub-acute low back pain supported by evidence, and create clinical recommendations and expert consensus for physiotherapists on clinical prescriptions.

DATA SOURCES

A systematic search was conducted in PubMed and the Cochrane Library for studies published within the previous 15 years.

REVIEW METHODS

Systematic review and meta-analysis, randomized controlled trials assessing patients with acute and sub-acute low back pain were included. Two reviewers independently screened relevant studies using the same inclusion criteria. The Physiotherapy Evidence Database and the Assessment of Multiple Systematic Reviews tool were used to grade the quality assessment of randomized controlled trials and systematic reviews, respectively. The final recommendation grades were based on the consensus discussion results of the Delphi of 22 international experts.

RESULTS

Twenty-one systematic reviews and 21 randomized controlled trials were included. Spinal manipulative therapy and low-level laser therapy are recommended for acute low back pain. Core stability exercise/motor control, spinal manipulative therapy, and massage can be used to treat sub-acute low back pain.

CONCLUSIONS

The consensus statements provided medical staff with appliable recommendations of physical therapy for acute and sub-acute low back pain. This consensus statement will require regular updates after 5-10 years.

The effectiveness of high-intensity laser therapy in individuals with neck pain: a systematic review and meta-analysis

OBJECTIVES

The primary objective of this meta-analysis was to determine whether high-intensity laser therapy (HILT) was effective in improving pain intensity, cervical range of motion (ROM), functional activity, and quality of life (QOL) in individuals with neck pain.

DATA SOURCES

PubMed, PEDro, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov were searched from inception to March 26, 2022.

STUDY SELECTION

Randomized controlled trials (RCTs) involving HILT for neck pain were selected.

DATA EXTRACTION AND DATA SYNTHESIS

Two raters were independent in data extraction. The methodological quality was evaluated using the PEDro scale, and the level of evidence was assessed using the GRADE system. RevMan5.4 was used for meta-analysis.

RESULTS

Eight RCTs were included and their PEDro scores were moderate to high. Compared with placebo, HILT was effective in improving pain intensity (SMD 2.12, 95%CI 1.24 to 3.00; moderate quality evidence), cervical flexion (SMD 1.31, 95%CI 0.27 to 2.35; moderate quality evidence), extension (SMD 1.43, 95%CI 0.24 to 2.63; moderate quality evidence), right lateral flexion (SMD 1.36, 95%CI 0.15 to 2.56; low-quality evidence). There was a trend of better outcome in functional activity after HILT (SMD 1.73, 95%CI -0.05 to 3.54; low quality evidence).

LIMITATIONS

There was limited information available on QOL.

CONCLUSION

HILT may be considered as an adjunctive treatment modality for neck pain. There was moderate quality evidence that HILT may improve pain intensity and cervical ROM in individuals with neck pain, but there was low quality evidence that HILT was not effective in improving functional activity.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42021254078 CONTRIBUTION OF THE PAPER.

Reliability of shear-wave elastography in assessing the stiffness of the nuchal fascia and the thickness of upper cervical muscles

OBJECTIVE

To determine the reliability of shear-wave elastography (SWE)in assessing the stiffness of the nuchal fascia and the thickness of upper cervical muscles in neutral head posture (NHP) or forward head posture (FHP).

METHODS

Sixteen healthy adults (mean age: 21.69 ± 1.01years, 9 females) were included. SWE mode was chosen to measure the nuchal fascia shear modulus and muscle thickness was measured in B-mode. Measurements were collected by two independent investigators on two different days. The intraclass correlation coefficient (ICC) was used to measure the relative reliability, and the standard error of measurement (SEM) were used to measure the absolute reliability.

RESULTS

Intra‑rater (ICC = 0.63-0.89) and inter-rater (ICC = 00.54-0.82) reliability for the nuchal fascia shear modulus were moderate to excellent. Intra‑rater (ICC = 00.64-0.96) and inter-rater (ICC = 00.48-0.86) reliability for upper cervical muscles thickness were moderate to excellent. The SEM percentage oscillated from 3.27% to 13.55%. There were significant differences(P < 0.05) between NHP and FHP on nuchal fascia shear modulus, right side splenius capitis muscle thickness and left side semispinalis capitis muscle thickness, but no significant differences(P > 0.05) were observed between the right and left sides. The upper cervical muscles thickness of males was significantly thicker(P < 0.01) than females while no significant differences were observed (P > 0.05) on the nuchal fascia shear modulus.

CONCLUSIONS

Ultrasound-based SWE may be a reliable tool for assessing the stiffness of the nuchal fascia and the thickness of upper cervical muscles in clinical practice.

REGISTRATION NUMBER

ChiCTR2200055736.

Effects of repetitive peripheral magnetic stimulation on spasticity evaluated with modified Ashworth scale/Ashworth scale in patients with spastic paralysis: A systematic review and meta-analysis

BACKGROUND

Spasticity is a common motor disorder resulting from upper motor neuron lesions. It has a serious influence on an individual's motor function and daily activity. Repetitive peripheral magnetic stimulation (rPMS) is a non-invasive and painless approach developed for therapeutic intervention in clinical rehabilitation. However, the effectiveness of this intervention on spasticity in patients with spastic paralysis remains uncertain.

OBJECTIVE

This study aimed to investigate the effectiveness of rPMS on spasticity, motor function, and activities of daily living in individuals with spastic paralysis.

METHODS

PubMed, PEDro, Embase, Cochrane Library, and Web of Science were searched for eligible papers with date up to March 31, 2022. Two independent researchers conducted study screening, data extraction, and methodological quality assessment. RCTs that explored the effects of rPMS on spasticity, motor function, and activities of daily living in patients with spastic paralysis were included for review. The Cochrane collaboration tool was used to assess methodological quality. The cumulative effects of available data were processed for a meta-analysis using Reedman software.

RESULTS

Eight studies with 297 participants were included. Most of the studies presented low to moderate risk of bias. Compared with the control group, the results showed that rPMS had a significant effect on spasticity (all spasticity outcomes: standardized mean difference [SMD] = -0.55, 95% confidence interval [CI]: -0.94 to -0.16, I 2 = 40%, and P = 0.006, Modified Ashworth Scale: mean difference [MD] = -0.48, 95% CI: -0.82 to -0.14, I 2 = 0%, and P = 0.006), motor function (Fugl-Meyer Assessment: MD = 4.17, 95% CI: 0.89 to 7.46, I 2 = 28%, and P = 0.01), and activities of daily living (Barthel Index: MD = 5.12, 95% CI: 2.58 to 7.67, I 2 = 0%, and P < 0.0001). No side effect was reported.

CONCLUSION

The meta-analysis demonstrated that the evidence supported rPMS in improving spasticity especially for passive muscle properties evaluated with Modified Ashworth Scale/Ashworth Scale, as well as motor function and daily activity of living in individuals with spastic paralysis.

STUDY REGISTRATION

The reviewed protocol of this study is registered in the international prospective register of systematic reviews (PROSPERO) (CRD42022322395).

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier CRD42022322395.

Exercise for Neuropathic Pain: A Systematic Review and Expert Consensus

Background: Neuropathic pain (NP), a severe and disruptive symptom following many diseases, normally restricts patients' physical functions and leads to anxiety and depression. As an economical and effective therapy, exercise may be helpful in NP management. However, few guidelines and reviews focused on exercise therapy for NP associated with specific diseases. The study aimed to summarize the effectiveness and efficacy of exercise for various diseases with NP supported by evidence, describe expert recommendations for NP from different causes, and inform policymakers of the guidelines.

Design: A systematic review and expert consensus.

Methods: A systematic search was conducted in PubMed. We included systematic review and meta-analysis, randomized controlled trials (RCTs), which assessed patients with NP. Studies involved exercise intervention and outcome included pain intensity at least. Physiotherapy Evidence Database and the Assessment of Multiple Systematic reviews tool were used to grade the quality assessment of the included RCTs and systematic reviews, respectively. The final grades of recommendation were based on strength of evidence and a consensus discussion of results of Delphi rounds by the Delphi consensus panel including 21 experts from the Chinese Association of Rehabilitation Medicine.

Results: Eight systematic reviews and 21 RCTs fulfilled all of the inclusion criteria and were included, which were used to create the 10 evidence-based consensus statements. The 10 expert recommendations regarding exercise for NP symptoms were relevant to the following 10 different diseases: spinal cord injury, stroke, multiple sclerosis, Parkinson's disease, cervical radiculopathy, sciatica, diabetic neuropathy, chemotherapy-induced peripheral neuropathy, HIV/AIDS, and surgery, respectively. The exercise recommended in the expert consensus involved but was not limited to muscle stretching, strengthening/resistance exercise, aerobic exercise, motor control/stabilization training and mind-body exercise (Tai Chi and yoga).

Conclusions: Based on the available evidence, exercise is helpful to alleviate NP intensity. Therefore, these expert consensuses recommend that proper exercise programs can be considered as an effective alternative treatment or complementary therapy for most patients with NP. The expert consensus provided medical staff and policymakers with applicable recommendations for the formulation of exercise prescription for NP. This consensus statement will require regular updates after five–ten years.

Traditional Chinese Mind and Body Exercises for Neck Pain: A Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Neck pain is common and can have a significant impact on patients' physical functionality, mobility, and quality of life (QOL). In clinical practice, traditional Chinese mind and body exercise (TCMBE) is a combination of different types of exercise based on traditional Chinese medicine, including qigong, tai chi, the 12-words-for-life-nurturing exercise, and so on, and many studies have found that it is safe and effective at helping patients with neck pain.

OBJECTIVE

The aim of this study was to investigate the effectiveness of TCMBE on pain intensity, functional mobility, and QOL in individuals with neck pain.

METHODS

The PubMed, MEDLINE, PEDro, and Embase databases were systematically searched for relevant studies. Randomized controlled trials reporting the effects of TCMBE on pain intensity, functional mobility, and QOL in individuals with neck pain were included. Screening, data extraction, and literature quality assessments were performed independently by two reviewers. RevMan5.4 software was used for data analysis.

RESULTS

Six studies with 716 participants met the inclusion criteria. Compared with the control groups, TCMBE had no therapeutic advantage in improving pain intensity (visual analogue scale: mean difference (MD) = 1.8, 95% confidence interval (CI): -7.70 to 11.46, and P = 0.70); functional mobility (neck disability index: MD = 0.15, 95% CI: -6.37 to 6.66, and P = 0.96; neck pain and disability scale: MD = 1.31, 95% CI: -4.10 to 6.71, and P = 0.64); or 36-item short-form health survey (SF-36) scores for physical function (MD = 5.58, 95% CI: -8.03 to 19.18, and P = 0.42), general health (MD = 1.87, 95% CI: -4.99 to 8.72, and P = 0.59), body pain (MD = 2.26, 95% CI: -3.80 to 8.32, and P = 0.46), vitality (MD = 6.24, 95% CI: -1.49 to 13.98, and P = 0.11), social function (MD = 8.06, 95% CI: -4.85 to 20.98, and P = 0.22), role physical (MD = -1.46, 95% CI: -8.54 to 5.62, and P = 0.69), or role emotional (MD = 6.5, 95% CI: -3.45 to 16.45, and P = 0.2). However, TCMBE was less effective at improving mental health results based on the SF-36 survey (MD = 3.37, 95% CI: 0.5 to 6.24, and P = 0.02).

CONCLUSIONS

Based on the meta-analysis, there is insufficient evidence to support the clinical use of TCMBE in improving pain intensity and enhancing functional mobility and QOL in individuals with neck pain.

Effects of adding whole-body vibration to routine day activity program on physical functioning in elderly with mild or moderate dementia: a randomized controlled trial

OBJECTIVE

To evaluate the effects of whole-body vibration (WBV) added to a routine activity program on lower limb strength, balance, and mobility among community-dwelling individuals with mild or moderate dementia, compared with the routine program alone.

METHODS

Fifty-four older adults (40 women; mean (SD) age: 79.8 (6.1) years) with mild or moderate dementia were recruited from two daycare centers. The participants were randomly allocated to undergo a routine day activity program combined with WBV training (WBV at 30 Hz, 2-mm peak-to-peak amplitude) or the routine program only without WBV for 9 weeks (18 sessions). The primary outcome was functional mobility, measured using the timed up-and-go test. The following secondary outcomes were evaluated: Berg Balance Scale, Tinetti balance assessment, time to complete 5 repetitions of sit-to-stand, Quality of Life in Alzheimer's disease questionnaire, and Activities-specific Balance Confidence scale. The attendance rate and incidence of adverse events were also recorded.

RESULTS

The attendance rate for the training was high (86.0%). The incidence of adverse events was low, with only two of the 27 participants in the WBV group reporting mild knee pain. While significant improvement in timed up-and-go, Berg Balance Scale, and Tinetti balance score was found in both groups, none of the outcomes demonstrated a significant group by time interaction.

CONCLUSIONS

WBV training is feasible and safe to use with people with mild or moderate dementia. However, it did not lead to further improvement in physical function and quality of life than the usual activity program provided at the daycare centers. Copyright © 2017 John Wiley & Sons, Ltd.

Physical exercise improves strength, balance, mobility, and endurance in people with cognitive impairment and dementia: a systematic review

QUESTION

Does physical exercise training improve physical function and quality of life in people with cognitive impairment and dementia? Which training protocols improve physical function and quality of life? How do cognitive impairment and other patient characteristics influence the outcomes of exercise training?

DESIGN

Systematic review with meta-analysis of randomised trials.

PARTICIPANTS

People with mild cognitive impairment or dementia as the primary diagnosis.

INTERVENTION

Physical exercise.

OUTCOME MEASURES

Strength, flexibility, gait, balance, mobility, walking endurance, dual-task ability, activities of daily living, quality of life, and falls.

RESULTS

Forty-three clinical trials (n=3988) were included. According to the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system, the meta-analyses revealed strong evidence in support of using supervised exercise training to improve the results of 30-second sit-to-stand test (MD 2.1 repetitions, 95% CI 0.3 to 3.9), step length (MD 5cm, 95% CI 2 to 8), Berg Balance Scale (MD 3.6 points, 95% CI 0.3 to 7.0), functional reach (3.9cm, 95% CI 2.2 to 5.5), Timed Up and Go test (-1second, 95% CI -2 to 0), walking speed (0.13m/s, 95% CI 0.03 to 0.24), and 6-minute walk test (50m, 95% CI 18 to 81) in individuals with mild cognitive impairment or dementia. Weak evidence supported the use of exercise in improving flexibility and Barthel Index performance. Weak evidence suggested that non-specific exercise did not improve dual-tasking ability or activity level. Strong evidence indicated that exercise did not improve quality of life in this population. The effect of exercise on falls remained inconclusive. Poorer physical function was a determinant of better response to exercise training, but cognitive performance did not have an impact.

CONCLUSION

People with various levels of cognitive impairment can benefit from supervised multi-modal exercise for about 60minutes a day, 2 to 3days a week to improve physical function. [Lam FMH , Huang MZ, Liao LR, Chung RCK, Kwok TCY, Pang MYC (2018) Physical exercise improves strength, balance, mobility, and endurance in people with cognitive impairment and dementia: a systematic review. Journal of Physiotherapy 64: 4-15].

Effects of whole-body vibration on balance and mobility in institutionalized older adults: a randomized controlled trial

OBJECTIVE

To investigate whether a comprehensive exercise program was effective in improving physical function among institutionalized older adults and whether adding whole-body vibration to the program conferred additional therapeutic benefits.

DESIGN

A single-blinded randomized controlled trial was conducted.

SETTING

This study was carried out in residential care units.

PARTICIPANTS

In total, 73 older adults (40 women, mean age: 82.3 ± 7.3 years) were enrolled into this study.

INTERVENTIONS

Participants were randomly allocated to one of the three groups: strength and balance program combined with whole-body vibration, strength and balance program without whole-body vibration, and social and recreational activities consisting of upper limb exercises only. All participants completed three training sessions per week for eight weeks.

OUTCOME MEASURES

Assessment of mobility, balance, lower limb strength, walking endurance, and self-perceived balance confidence were conducted at baseline and immediately after the eight-week intervention. Incidences of falls requiring medical attention were recorded for one year after the end of the training period.

RESULTS

A significant time × group interaction was found for lower limb strength (five-times-sit-to-stand test; P = 0.048), with the exercise-only group showing improvement (pretest: 35.8 ± 16.1 seconds; posttest: 29.0 ± 9.8 seconds), compared with a decline in strength among controls (pretest: 27.1 ± 10.4 seconds; posttest: 28.7 ± 12.3 seconds; P = 0.030). The exercise with whole-body vibration group had a significantly better outcome in balance confidence (pretest: 39.2 ± 29.0; posttest: 48.4 ± 30.6) than the exercise-only group (pretest: 35.9 ± 24.8; posttest: 38.2 ± 26.5; P = 0.033).

CONCLUSION

The exercise program was effective in improving lower limb strength among institutionalized older adults but adding whole-body vibration did not enhance its effect. Whole-body vibration may improve balance confidence without enhancing actual balance performance.

Whole-Body Vibration Intensities in Chronic Stroke: A Randomized Controlled Trial

PURPOSE

A single-blinded randomized controlled study was conducted to investigate the effects of different whole-body vibration (WBV) intensities on body functions/structures, activity, and participation in individuals with stroke.

METHODS

Eighty-four individuals with chronic stroke (mean age = 61.2 yr, SD = 9.2) with mild to moderate motor impairment (Chedoke-McMaster Stroke Assessment lower limb motor score: median = 9 out of 14, interquartile range = 7-11.8) were randomly assigned to a low-intensity WBV, high-intensity WBV, or control group. The former two groups performed various leg exercises while receiving low-intensity and high-intensity WBV, respectively. Controls performed the same exercises without WBV. All individuals received 30 training sessions over an average period of 75.5 d (SD = 5.2). Outcome measurements included knee muscle strength (isokinetic dynamometry), knee and ankle joint spasticity (Modified Ashworth Scale), balance (Mini Balance Evaluation Systems Test), mobility (Timed-Up-and-Go test), walking endurance (6-Minute Walk Test), balance self-efficacy (Activities-specific Balance Confidence scale), participation in daily activities (Frenchay Activity Index), perceived environmental barriers to societal participation (Craig Hospital Inventory of Environmental Factors), and quality of life (Short-Form 12 Health Survey). Assessments were performed at baseline and postintervention.

RESULTS

Intention-to-treat analysis revealed a significant time effect for muscle strength, Timed-Up-and-Go distance, and oxygen consumption rate achieved during the 6-Minute Walk Test, the Mini Balance Evaluation Systems Test, the Activities-specific Balance Confidence scale, and the Short-Form 12 Health Survey physical composite score domain (P < 0.05). However, the time-group interaction was not significant for any of the outcome measures (P > 0.05).

CONCLUSION

The addition of the 30-session WBV paradigm to the leg exercise protocol was no more effective in enhancing body functions/structures, activity, and participation than leg exercises alone in chronic stroke patients with mild to moderate motor impairments.

Effect of Whole-Body Vibration on Neuromuscular Activation of Leg Muscles During Dynamic Exercises in Individuals With Stroke

Liao, L-R, and Pang, MYC. Effect of whole-body vibration on neuromuscular activation of leg muscles during dynamic exercises in individuals with stroke. J Strength Cond Res 31(7): 1954-1962, 2017-This study examined the leg muscle activity during exposure to different whole-body vibration (WBV) intensities while performing various dynamic exercises in patients with chronic stroke. Thirty patients with chronic stroke performed a series of dynamic exercises under 3 conditions: (a) low-intensity WBV (peak acceleration: 0.96 units of gravity of Earth [g]), (b) high-intensity WBV (1.61 g), and (c) no WBV. Neuromuscular activation was recorded with surface electromyography (EMG) on bilateral biceps femoris (BF), vastus lateralis, tibialis anterior (TA), and gastrocnemius (GS) in both legs and was reported as EMGrms (root mean square) normalized to % maximal voluntary contraction. The EMG amplitude of all tested muscles was significantly increased by adding WBV during dynamic exercise (p ≤ 0.05). The EMG amplitude of BF, TA, and GS during exposure to high-intensity WBV was significantly greater than low-intensity WBV (p ≤ 0.05). The increase in EMG amplitude caused by WBV was exercise dependent in GS and TA (p ≤ 0.05). The EMG response to WBV in GS and BF in the affected leg was significantly greater than the corresponding muscles in the unaffected leg (p ≤ 0.05). The extent of WBV-induced muscle activity was dependent on the dynamic exercise, WBV intensity, and muscle trained among patients with chronic stroke.

Effects of whole body vibration on muscle spasticity for people with central nervous system disorders: a systematic review

Objectives:

To examine the effects of whole-body vibration on spasticity among people with central nervous system disorders.

Methods:

Electronic searches were conducted using CINAHL, Cochrane Library, MEDLINE, Physiotherapy Evidence Database, PubMed, PsycINFO, SPORTDiscus and Scopus to identify randomized controlled trials that investigated the effect of whole-body vibration on spasticity among people with central nervous system disorders (last search in August 2015). The methodological quality and level of evidence were rated using the PEDro scale and guidelines set by the Oxford Centre for Evidence-Based Medicine.

Results:

Nine trials with totally 266 subjects (three in cerebral palsy, one in multiple sclerosis, one in spinocerebellar ataxia, and four in stroke) fulfilled all selection criteria. One study was level 1b (PEDro⩾6 and sample size>50) and eight were level 2b (PEDro<6 or sample size ⩽50). All three cerebral palsy trials (level 2b) reported some beneficial effects of whole-body vibration on reducing leg muscle spasticity. Otherwise, the results revealed no consistent benefits on spasticity in other neurological conditions studied. There is little evidence that change in spasticity was related to change in functional performance. The optimal protocol could not be identified. Many reviewed studies were limited by weak methodological and reporting quality. Adverse events were minor and rare.

Conclusion:

Whole-body vibration may be useful in reducing leg muscle spasticity in cerebral palsy but this needs to be verified by future high quality trials. There is insufficient evidence to support or refute the notion that whole-body vibration can reduce spasticity in stroke, spinocerebellar ataxia or multiple sclerosis.

The effects of whole body vibration therapy on bone mineral density and leg muscle strength in older adults: a systematic review and meta-analysis

OBJECTIVE

A systematic review and meta-analysis of randomized controlled trials was undertaken to determine whether whole body vibration improves bone mineral density and leg muscle strength in older adults.

DATA SOURCES

Sources included MEDLINE, CINAHL, EMBASE, PEDro, PubMed, Science Citation Index and the reference list of each eligible article.

REVIEW METHODS

Article search and selection was performed independently by two researchers. The methodological quality of each selected article was rated by the PEDro scale.

RESULTS

Thirteen randomized trials (18 articles) totalling 896 subjects fulfilled the selection criteria. Four were considered to have good or excellent methodological quality and the rest were rated as fair. Meta-analyses revealed that whole body vibration has no significant effect on hip or lumbar spine bone mineral density in older women when compared with no intervention or active exercise (P > 0.05). Whole body vibration, however, had a significant treatment effect on knee extension dynamic strength (standardized mean difference = 0.63, P = 0.006), leg extension isometric strength (standardized mean difference = 0.57, P = 0.003), and functional measures of leg muscle strength such as jumping height (standardized mean difference = 0.51, P = 0.010) and performance in sit-to-stand (standardized mean difference = 0.72, P < 0.001) among older adults compared with no intervention.

CONCLUSION

Whole body vibration is beneficial for enhancing leg muscle strength among older adults. However, the review suggests that whole body vibration has no overall treatment effect on bone mineral density in older women. No randomized trial has examined the effects of whole body vibration on bone mineral density in older men.

A modified radiofrequency-assisted approach to right hemihepatectomy

AIMS

To evaluate a modified radiofrequency-assisted approach to right hemihepatectomy.

METHODS

Following a bilateral subcostal incision and intraoperative ultrasonography, the liver was mobilized in the standard manner, and a cholecystectomy was performed. The portal vein was isolated, encircled, and ligated. After demarcating the liver parenchyma, coagulation necrosis was achieved using a radiofrequency-assisted device along the line demarcated for transecting the liver parenchyma. The actual transection of the liver parenchyma and the right portal vein was done using a surgical scalpel along the radiofrequency-coagulated line. The right hepatic vein was coagulated using the radiofrequency sealer or by stitching in the resection plane. The hepatic artery was not dissected and was sealed together with the bile ducts in the resection plane using the radiofrequency instrument. The hepatic vein was not divided.

RESULTS

Between July 2005 and July 2006, a total of 49 liver resections were performed in our unit. Of these, the radiofrequency-assisted technique was used in 33 cases with metastatic disease; 14 of these cases had right hemihepatectomies, including 2 repeat resections. The mean operation time was 180min (range, 120-240min), and the average blood transfusion was 0.14U (range, 0-2U). Postoperatively, there was no morbidity, such as bleeding, infection, or biliary fistula, related to the liver resection technique, and no patients died as a result of surgery. In 8 out of the 14 right hemihepatectomies, a right-sided pleural effusion was observed; 3 of them required evacuation.

CONCLUSION

This paper describes a modified radiofrequency-assisted hemihepatectomy, which allows one to obtain control of the portal blood flow going into the resected part of liver. The modified approach appears to be simple and safe.