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Development of a perfused ex vivo tumor-mimic model for the training of laparoscopic radiofrequency ablation

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Abstract

Background

Laparoscopic radiofrequency ablation (RFA) is a safe and effective method for tumor destruction in patients with unresectable liver tumors. However, accurate probe placement using laparoscopic ultrasound guidance is required to achieve complete tumor ablation. This study aimed to develop a perfusable ex vivo tumor-mimic model for laparoscopic radiofrequency ablation training.

Methods

After rinsing the prepared liver vessels with anticoagulants, porcine livers were perfused. Tumor-mimics were created by injecting a mixture consisting of 3% agarose, 3% cellulose, 7% glycerol, and 0.05% methylene blue, creating hyperechoic lesions in ultrasound. Heparinized porcine blood was used as perfusion medium. Continuous perfusion of the porcine liver was provided by connection of a pump system to the portal vein and the vena cava inferior. Laparoscopic RFA techniques were taught using a laparoscopic pelvi-trainer.

Results

A total of 30 laparoscopic ablations were performed in four porcine livers. The simulated “tumors” were clearly visible on laparoscopic ultrasound and not felt during placement of the RFA probe. In addition, color duplex ultrasound showed clear signals indicating for a sufficient liver perfusion.

Conclusion

Laparoscopic RFA requires advanced laparoscopic ultrasound skills for an accurate placement of the RFA probe. The perfused tumor-mimic model presented is a safe, easy, effective, and economic method to improve and train laparoscopic RFA skills on porcine liver tissue.

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References

  1. Hildebrand P, Leibecke T, Kleemann M, Mirow L, Birth M, Bruch HP, Burk C (2006) Influence of operator experience in radiofrequency ablation of malignant liver tumours on treatment outcome. Eur J Surg Oncol 32: 430–434

    Article  PubMed  CAS  Google Scholar 

  2. John TG, Greig JD, Crosbie JL, Miles WFA, Garden OJ (1994) Superior staging of liver tumors with laparoscopy and laparoscopic ultrasound. Ann Surg 6: 711–719

    Article  Google Scholar 

  3. Mulier S, Mulier P, Ni Y, Miao Y, Dupas B, Marchal G, De Wever I, Michel L (2002) Complications of radiofrequency coagulation of liver tumors. Br J Surg 89: 1206–1222

    Article  PubMed  CAS  Google Scholar 

  4. Mulier S, Ni Y, Jamart J, Ruers T, Marchal G, Michel L (2005) Local recurrence after hepatic radiofrequency coagulation: multivariante meta-analysis and review of contributing factors. Ann Surg 242: 158–171

    Article  PubMed  Google Scholar 

  5. Peters JH, Ellison EC, Innes JT, Liss JL, Nichlos KE, Lomano JM, Roby SR, Front ME, Carey LC (1991) Safety and efficacy of laparoscopic cholecystectomy. A prospective analysis of 100 initial patients. Ann Surg 213: 3–12

    Article  PubMed  CAS  Google Scholar 

  6. Poon RT, Ng KK, Lam CM, Ai V, Yuen J, Fan ST, Wong J (2004) Learning curve for radiofrequency ablation of liver tumors: prospective analysis of initial 100 patients in a tertiary institution. Ann Surg 239: 441–449

    Article  PubMed  Google Scholar 

  7. Ramsay CR, Grant AM, Wallace SA, Garthwaite PH, Monk AF, Russell IT (2001) Statistical assessment of the learning curves of health technologies. Health Technol Assess 5: 1–79

    PubMed  CAS  Google Scholar 

  8. Santambrogio R, Podda M, Zuin M, Bertolini E, Bruno S, Cornalba GP, Costa M, Montorsi M (2003) Safety and efficacy of laparoscopic radiofrequency of hepatocellular carcinoma in patients with liver cirrhosis. Surg Endosc 17: 1826–1832

    Article  PubMed  CAS  Google Scholar 

  9. Schlachta CM, Mamazza J, Seshadri PA, Cadeddu M, Gregoire R, Poulin EC (2001) Defining a learning curve for laparoscopic colorectal resection. Dis Colon Rectum 44: 217–222

    Article  PubMed  CAS  Google Scholar 

  10. Scott DM, Young WN, Watamull LM, Lindberg G, Fleming JB, Rege RV, Brown RJ, Jones DB (2000) Development of an in vivo tumor-mimic model for learning laparoscopic radiofrequency ablation. J Gastrointest Surg 4: 629–635

    Article  Google Scholar 

  11. Scott DJ, Young WN, Watumull LM, Lindberg G, Fleming JB, Huth JF, Rege RV, Jeyarajah DR, Jones DB (2001) Accuracy and effectiveness of laparoscopic vs open hepatic radiofrequency ablation. Surg Endosc 15: 135–140

    Article  PubMed  CAS  Google Scholar 

  12. Siperstein A, Rogers S, Hansen P, Gitomirsky A (1997) Laparoscopic thermal ablation of hepatic neuroendocrine metastases. Surgery 122: 1147–1155

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Philipp Hildebrand.

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Hildebrand, P., Kleemann, M., Roblick, U. et al. Development of a perfused ex vivo tumor-mimic model for the training of laparoscopic radiofrequency ablation. Surg Endosc 21, 1745–1749 (2007). https://doi.org/10.1007/s00464-007-9216-x

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  • DOI: https://doi.org/10.1007/s00464-007-9216-x

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