Accuracy and effectiveness of laparoscopic vs open hepatic radiofrequency ablation

Background: The purpose of this study was to compare the accuracy (in terms of ultrasound-guided probe placement) and the effectiveness (in terms of pathologic tumor-free margin) of laparoscopic vs open radiofrequency (RF) ablation. Methods: Using a previously validated tissue-mimic model, 1-cm simulated hepatic tumors were ablated in 10 pigs randomized to open or laparoscopic techniques. Energy was applied until tissue temperature reached 100°C (warm-up) and thereafter for 8 min. A pathologist blinded to technique examined all specimens immediately after treatment. Analysis was by Fisher's exact test and the Mann-Whitney U test; p < 0.05 was considered significant. Results: Off-center distance (3.5 ± 1.6 vs 4.2 ± 1.4 mm), size (24.7 ± 3.1 vs 25.6 ± 3.8 mm), symmetry (40% vs 73%), margin positivity (33% vs 9%), and margin distance (1.1 ± 1.2 vs 2.2 ± 1.6 mm) were not significantly different between laparoscopic (n = 15) and open (n = 11) ablations, respectively. The proportion of round/ovoid lesions (20% vs 64%) was lower (p = 0.043), and warm-up time (20.2 ± 14.0 vs 10.7 ± 7.5) was longer (p = 0.049) for the laparoscopic than for the open groups, respectively. Conclusion: Accurate probe placement can be achieved using laparoscopic and open RF ablation techniques. The physiologic effects of laparoscopy may alter ablation shape and warm-up time. Additional studies are needed to establish effective ways of achieving complete tumor destruction.