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The Procedure
Preoperative Examination
All patients are seen by Dr. Siperstein prior to surgery. To determine the most actual state of the liver tumor, we request a recent CT scan of the abdomen, usually taken within a week before surgery. Routine blood tests are obtained as well as specific liver tumor markers as indicated.
The Operation
Radiofrequency ablation of liver tumors is performed via a laparoscopic surgical technique which uses a long, thin instrument and a video telescope passed through small incisions in the abdominal wall, similar to the technique used in the very common procedure, laparoscopic cholecystectomy.
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Typical view in the Operating room. Usually there are only two 2cm cuts required for RF-Ablation. In the foreground you see the videocamera, then the laparoscopic ultrasound device; the needle is the device with the gray cup. |
In the operating room under general anesthesia, a diagnostic
laparoscopy (evaluation with video telescope) is performed. This
allow us to examine almost the whole abdomen for any suspicious areas
outside the liver. Laparoscopic ultrasound of the liver is then
performed, and all lesions within the liver are located and mapped.
Blood supply to these lesions is evaluated by Doppler (color-flow)
analysis, and biopsies of the suspicious areas are obtained, also
using ultrasound guidance.
The radiofrequency thermal ablation catheter is placed through the
skin and into the liver, using ultrasound to guide the tip of the
probe into the center of the tumor. The prongs are deployed into the
tumor, and a 10 to 15 minute ablation cycle is initiated. Dynamic
monitoring is afforded by thermocouples in the tips of the prongs
which provide temperature feedback. Ultrasound monitoring of the
microbubble formation is also noted and serves as additional
confirmation of the ablation process. In bigger lesions overlapping
ablations are performed by placing the needle outside of the center
of the tumor with a following ablation cycle.
After the operation
Following surgery all patients are taken to the recovery room for observation. When fully stabilized you are brought to the overnight short stay unit, where you can be with your family. It is not uncommon to feel tired or experience abdominal distention. Some patients have noted minor left sided shoulder discomfort lasting a few hours. This is usually caused by a nerve irritation common in laparoscopic surgery. You will receive oral pain medication to minimize discomfort.
Most patients will be up and out of bed the same day. We encourage
all patients to sit in a chair or walk around if they feel
comfortable.
It is also very important to comply with the breathing exercises.
Fresh air in all parts of the lung avoids the most common
complication after every surgery - collapse of small parts of the
lung and likely inflammation.
You can expect to be discharged the following day if the doctor agrees at the morning visit. In fact, over 95% of our patients went home the next day.
Special postoperative instructions are handed out to our patients.
Postoperative Follow-up
Depending where you live, follow up examinations can be either performed at the Cleveland Clinic or with your primary physician.
You should see Dr. Siperstein or your primary doctor initally a week after surgery and then every third month. All postoperative examinations include blood drawing and a CT scan of the abdomen. This is a very common examination schedule for a patient diagnosed with liver cancer. In addition you are asked to fill out a questionnaire about your life activities.
If you choose your primary physician for follow up, we'll ask your doctor for copies of the CT scans with the radiologist report and laboratory results.And you can still call our clinical coordinator for any problem after your liver tumor ablation.
