Radiofrequency-assisted partial splenectomy: Histopathological and immunological assessment of the splenic remnant in a porcine model.

BACKGROUND: Radiofrequency (RF) ablation has recently been expanded from palliative treatment into tissue-preserving surgery with controversial results. RF has been accused of septic complications and dysfunction of the target organ due to uncontrolled energy distribution. The aim of this study was to evaluate the short- and long-term implications of RF energy to the remaining splenic tissue after laparoscopic and open RF-assisted partial splenectomy. METHODS: Thirty pigs randomly underwent laparoscopic RF partial splenectomy (n = 10), open RF partial splenectomy (n = 10) using the Radionics Cooltip radiofrequency system (Tyco Hellas), while a third group (n = 10) underwent the conventional procedure. Intraoperative parameters were recorded. Complete blood counts, along with splenic function tests, were estimated preoperatively, immediately postoperatively, and at 1 and 6 months after the procedure. Histology was also evaluated. A separate group of five animals randomly undergo conventional resection (n = 2) and open RF resection (n = 3). These animals were sacrificed 1 month postoperatively and were used for histology only. RESULTS: The blood loss was minimal in both RF groups. No septic complications were observed throughout the follow-up period. Laboratory values at 1 month postoperatively showed decreased splenic function in both RF groups. Histology at 1 month was indicative of a chronic inflammatory reaction to the RF groups whereas, in the control group, prominent hypervascular granulated tissue was observed. Six months postoperatively, the platelet count remained elevated in the RF groups. Histology revealed intense fibrosis at the ablation site, as opposed to friable granulated tissue in the conventional group. CONCLUSIONS: Radiofrequency energy acts as an excellent haemostatic tool. The healing process shifts from the thermal injury to chronic inflammatory reaction and, 6 months later, to intense fibrosis as opposed to the hypervascular granulated tissue presented in the nonablated spleen. However, the longer the RF energy is applied, the more the splenic function is transiently affected.

Modified radiofrequency-assisted liver resection: a new device.

BACKGROUND: Radiofrequency ablation (RF) is emerging as new therapeutic method for the management of hepatic tumors. So far the RF-assisted hepatectomy has been described using an electrode initially designed for ablation of unresectable tumors. Herein, we describe a new technique for liver resection using a bipolar radiofrequency device. METHOD: Ten patients undergo liver resection using a bipolar radiofrequency device. A minimal zone of desiccation around the tumor is created between pairs of opposing electrodes as a result of a minimum amount of energy released. This coagulated plane can be divided with a scalpel. RESULTS: The liver parenchyma was divided with minimal blood loss. No intensive care unit admission was needed. There was no postoperative biliary leak or any other septic complication. CONCLUSION: The technique is safe and feasible, simplifies liver resection and appears to be associated with minimal morbidity and maximum liver parenchyma preservation.