Surgical resectioning combined with microwave ablation provides a safe and effective method for multiple colorectal cancer liver metastases, especially when the residual liver volume is insufficient. This technique simplifies the operation procedures, reduces the risk of complications such as bleeding and bile leakage, shortens the operation time, and accelerates the postoperative recovery. In addition to colorectal cancer liver metastases, this method can also be applied to multiple primary liver cancer or other secondary liver tumors.
It's recommended to master the basic theory of liver ultrasound and practice portal vein puncture, guided by laparoscopic ultrasound before using this technique. Insert a 12 centimeter trocar into the navel and abdominal cavity for erasion. Place five centimeter trocars under the xiphoid process and below the costal margin of the right midclavicular line.
Examine the cavity and the parenchymal organs by placing the naval trocar into the laparoscope. Using an ultrasonic knife, separate the round and flacid form ligaments attached to the abdominal wall and liver diaphragm. After intravenous injection of the contrast agent, place the laparoscopic probe into the abdominal cavity.
Then examine the liver by moving the probe over the tissues. Locate the contrast defined metastatic tumors in the S5 and S7 liver segments using ultrasound. Next, insert two five centimeter trocars to aid in the procedure.
Confirm the location of the tumors using ultrasound probe. Remove the connecting tissues using an ultrasound scalpel. Expose the hepatic pedicles between segments two and three and sever the branch of the umbilical fissure vein.
Then start dissecting the parenchyma of the left lateral lobe using an ultrasonic scalpel. Continue the dissection through the entire lobe. Then sever the left lateral lobe.
Collect the dissected lobe. Then detach the liver by removing the surrounding connecting tissue. Next, using the laparoscopic ultrasound, locate the tumor boundaries and mark the liver surface.
Detect the location of liver metastases using an ultrasound probe and mark the location keeping less than one centimeter of margin from the tumor. Insert the microwave ablation needle into the abdominal cavity through the percutaneous puncture. Insert the needle into the center of the tumor under the laparoscopic probe guidance and perform microwave ablation.
Remove the needle after complete ablation using an ultrasonic scalpel, electro coagulate the liver parenchyma sections. Continue the electrocoagulation until the tumor tissue is excised. Collect the tissue and place it in the bag.
Place a hemostatic gauze. Then clean the abdominal cavity by rinsing the tissue and removing the hemostatic gauze. Release the umbilical fissure vein and remove the tissue debris.
Finally place the drainage tube. The surgery had a runtime of 130 minutes. Liver ablation was successful at under 55 watts for five minutes, resulting in low intraoperative blood loss of 50 milliliters.
Postoperative complications were not observed, which resulted in patient discharge eight days after the surgery. Laparoscopic ultrasound scan of the whole liver is very important after the injection of contrast agent. It may reveal lesions that are difficult to find in preoperative imaging such as MR or ct.
