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首页> 外文期刊>Surgical Endoscopy >Multimedia manuscript. Dual-scope guided (simultaneous thoraco-laparoscopic) transthoracic transdiaphragmatic intraoperative radiofrequency ablation for hepatocellular carcinoma located beneath the diaphragm.
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Multimedia manuscript. Dual-scope guided (simultaneous thoraco-laparoscopic) transthoracic transdiaphragmatic intraoperative radiofrequency ablation for hepatocellular carcinoma located beneath the diaphragm.

机译：多媒体手稿。双镜引导（同时胸腔镜-腹腔镜）经胸trans肌术中射频消融治疗located肌下方的肝细胞癌。

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BACKGROUND: Among treatment modalities for unresectable hepatocellular carcinoma (HCC), radiofrequency ablation (RFA) is getting popular due to low morbidity and its effectiveness. However, when the tumor is located just under the diaphragm, a percutaneous approach for RFA is often impossible because of the difficulty in visualizing the tumor with conventional ultrasonographic examination. METHOD: Simultaneous thoraco-laparoscopic transthoracic transdiaphragmatic intraoperative RFA was performed on a 55 year-old male with HCC just beneath the diaphragm as well as laparoscopic RFA for dysplastic nodule near the gallbladder. Most of all, the patient wanted to undergo liver transplantation for the HCC and underlying liver cirrhosis. Therefore we chose to provide this procedure as a bridge to the liver transplantation. A total of four trocars (12 mm, 10 mm, 5 mm trocars for laparoscopy, and one 5 mm trocar for thoracoscopy), a 10 mm flexible laparoscope, a 5 mm thoracoscpe, and a laparoscopic ultrasound were used for this surgical procedure. After finishing laparoscopic RFA for dysplastic nodule near the gallbladder, the patient was placed into the left lateral decubitus for dual-scope guided transthoracic transdiaphragmatic intraoperative RFA. Complete separation of the diaphragm from the hepatic dome and good visualization of the subdiaphragmatic vessels provided a safe procedure without any injury to the diaphragm and other vessels. RESULTS: The operative time was 240 minutes and the blood loss was zero. The postoperative course was uneventful. The diet was started on the operative day. A chest tube and an abdominal drain was removed on first day after surgery. The patient discharged on the second day after surgery. The patient has been followed up for three months after the dual-scope guided intraoperative RFA without any evidence of tumor recurrence. He is now actively being evaluated for liver transplantation. CONCLUSION: Dual-scope guided (simultaneous thoraco-laparoscopic) transthoracic transdiaphragmatic intraoperative RFA is an easy, safe, and effective minimal invasive modality for treatment of the selective patient with HCC, with liver cirrhosis, which is located immediately under the diaphragm. Further experiences and a long term follow up is mandatory.
机译：背景：在不可切除的肝细胞癌（HCC）的治疗方式中，射频消融（RFA）由于其低发病率及其有效性而变得流行。但是，当肿瘤位于the下时，由于常规超声检查难以将肿瘤可视化，因此通常不可能采用经皮RFA疗法。方法：对55岁男性HCC在the肌下方同时行胸腹腔镜经胸经dia肌射频消融，同时对胆囊附近的增生性结节进行腹腔镜RFA。最重要的是，患者希望因肝癌和潜在的肝硬化接受肝移植。因此，我们选择提供该程序作为肝移植的桥梁。该手术总共使用了四根套管针（用于腹腔镜检查的为12 mm，10 mm，5 mm套管针，用于胸腔镜检查的为一5 mm套管针），10 mm柔性腹腔镜，5 mm胸腔镜和腹腔镜超声。在完成胆囊附近增生性结节的腹腔镜RFA检查后，将患者放进左侧卧位，进行双镜引导下经胸dia肌术中RFA检查。隔膜与肝穹顶的完全分离以及dia下血管的良好可视化提供了一种安全的程序，而不会损坏隔膜和其他血管。结果：手术时间为240分钟，失血量为零。术后过程很顺利。在手术当天开始饮食。手术后第一天取下胸管和腹腔引流管。病人在手术后第二天出院。在双镜指导的术中RFA术后对患者进行了三个月的随访，无肿瘤复发的迹象。现在，他正在积极接受肝脏移植的评估。结论：双镜引导下（经胸腹腔镜同时行）经胸trans肌术中射频消融术是一种简便，安全，有效的微创方式，用于治疗选择性地伴有肝硬化的肝癌患者，其位于the下。必须有进一步的经验和长期的随访。

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