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. 2018 Mar 1;31(1):e1346.
doi: 10.1590/0102-672020180001e1346.

PERCUTANEOUS RADIOFREQUENCY ASSISTED LIVER PARTITION WITH PORTAL VEIN EMBOLIZATION FOR STAGED HEPATECTOMY (PRALPPS)

[Article in English, Portuguese]
Mariano E Giménez  1   2   3   4 , Eduardo J Houghton  1   2   5 , C Federico Davrieux  2   3   4 , Edgardo Serra  2   6 , Patrick Pessaux  3   4   7 , Mariano Palermo  1   2 , Pablo A Acquafresca  2 , Caetano Finger  2   8 , Bernard Dallemagne  3   4   7 , Jacques Marescaux  3   4
Affiliations

PERCUTANEOUS RADIOFREQUENCY ASSISTED LIVER PARTITION WITH PORTAL VEIN EMBOLIZATION FOR STAGED HEPATECTOMY (PRALPPS)

[Article in English, Portuguese]
Mariano E Giménez et al. Arq Bras Cir Dig. .

Abstract
in English, Portuguese

Background: When a major hepatic resection is necessary, sometimes the future liver remnant is not enough to maintain sufficient liver function and patients are more likely to develop liver failure after surgery.

Aim: To test the hypothesis that performing a percutaneous radiofrecuency liver partition plus percutaneous portal vein embolization (PRALPPS) for stage hepatectomy in pigs is feasible.

Methods: Four pigs (Sus scrofa domesticus) both sexes with weights between 25 to 35 kg underwent percutaneous portal vein embolization with coils of the left portal vein. By contrasted CT, the difference between the liver parenchyma corresponding to the embolized zone and the normal one was identified. Immediately, using the fusion of images between ultrasound and CT as a guide, radiofrequency needles were placed percutaneouslyand then ablated until the liver partition was complete. Finally, hepatectomy was completed with a laparoscopic approach.

Results: All animals have survived the procedures, with no reported complications. The successful portal embolization process was confirmed both by portography and CT. In the macroscopic analysis of the pieces, the depth of the ablation was analyzed. The hepatic hilum was respected. On the other hand, the correct position of the embolization material on the left portal vein could be also observed.

Conclusion: "Percutaneous radiofrequency assisted liver partition with portal vein embolization" (PRALLPS) is a feasible procedure.

Racional:: Quando grande ressecção hepática é necessária, às vezes, o fígado remanescente não é suficiente para manter a função hepática e os pacientes são mais propensos a desenvolver insuficiência hepática após a operação.

Objetivo:: Testar a hipótese de que a realização de uma divisão do fígado com radiofreqüência percutânea mais a embolização percutânea da veia porta (PROPS) para a hepatectomia regrada em porcos é viável.

Métodos:: Quatro porcos (Sus scrofa domesticus) ambos os sexos com pesos entre 25 a 35 kg foram submetidos à embolização percutânea da veia porta com espirais da veia porta esquerda. Por TC contrastada, a diferença entre o parênquima hepático correspondente à zona embolizada e a normal foi identificada. Imediatamente, usando a fusão de imagens entre ultrassom e CT guiada, as agulhas de radiofrequência foram colocadas percutaneamente e depois foram cortando até a partição do fígado estar completa. Finalmente, a hepatectomia foi completada com abordagem laparoscópica.

Resultados:: Todos os animais sobreviveram aos procedimentos, sem complicações. O sucesso do processo de embolização do portal foi confirmado por portografia e CT. Na análise macroscópica das peças, analisou-se a profundidade da ablação. O hilo hepático foi respeitado. Por outro lado, a posição correta do material de embolização na veia porta esquerda também pôde ser observada.

Conclusão:: “Partição do fígado assistida por radiofrequência percutânea com embolização da veia porta” (PRALLPS) é um procedimento viável.

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Conflict of interest statement

Conflict of interest: Professor Jacques Marescaux is the President of both IRCAD and IHU-Strassbourg which are partly funded by Karl Storz, Medtronic and Siemens Health Care.

Figures

FIGURE 1
FIGURE 1. A) Left portal vein showed by portography; B) right portal vein after embolization; C) CT scan with IV contrast after portal vein embolization
FIGURE 2
FIGURE 2. A) Placement the RFA needle using fusion image between US and CT; B) CT scan checking the correct position of the needles
FIGURE 3
FIGURE 3. CT scan after ablation
FIGURE 4
FIGURE 4. Aspect of liver after ablation: hemihepatectomy by open approach
FIGURE 5
FIGURE 5. Hemihepatectomy by laparoscopic surgery
FIGURE 6
FIGURE 6. A) CT after laparoscopic hepatectomy; B) right hepatic lobe, right portal vein branch and gallbladder.
See this image and copyright information in PMC

References

    1. Angle JF, Siddiqi NH, Wallace MJ, et al. Quality Improvement Guidelines forPercutaneous Transcatheter Embolization. - DOI - PubMed
    1. Chan AC, Chok KS, Das JW. Impact of split completeness on future liver remnant hypertrophy in associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in hepatocellular carcinoma Complete-ALPPS versus partial-ALPPS. Surgery. 2017;161(2):357–364. - PubMed
    1. Cillo U. Totally Laparoscopic Microwave Ablation and Portal Vein Ligation for Staged Hepatectomy A New Minimally Invasive Two-Stage Hepatectomy. Ann Surg Oncol. 2015;22(8):2787–2788. - PubMed
    1. Court FG, Wemyss-Holden SA, Morrison CP. Segmental nature of the porcine liver and its potential as a model for experimental partial hepatectomy. Br J Surg. 2003;90(4):440–444. - PubMed
    1. Croome KP, Mao SA, Glorioso JM. Characterization of a porcine model for associating liver partition and portal vein ligation for a staged hepatectomy. HPB (Oxford) 2015;17(12):1130–1136. - PMC - PubMed