Radiofrequency Ablation of Rabbit Liver In Vivo: Effect of the Pringle Maneuver on Pathologic Changes in Liver Surrounding the Ablation Zone

Objective We wished to evaluate the effect of the Pringle maneuver (occlusion of both the hepatic artery and portal vein) on the pathologic changes in the hepatic vessels, bile ducts and liver parenchyma surrounding the ablation zone in rabbit livers. Materials and Methods Radiofrequency (RF) ablation zones were created in the livers of 24 rabbits in vivo by using a 50-W, 480-kHz monopolar RF generator and a 15-gauge expandable electrode with four sharp prongs for 7 mins. The tips of the electrodes were placed in the liver parenchyma near the porta hepatis with the distal 1 cm of their prongs deployed. Radiofrequency ablation was performed in the groups with (n=12 rabbits) and without (n=12 rabbits) the Pringle maneuver. Three animals of each group were sacrificed immediately, three days (the acute phase), seven days (the early subacute phase) and two weeks (the late subacute phase) after RF ablation. The ablation zones were excised and serial pathologic changes in the hepatic vessels, bile ducts and liver parenchyma surrounding the ablation zone were evaluated. Results With the Pringle maneuver, portal vein thrombosis was found in three cases (in the immediate [n=2] and acute phase [n=1]), bile duct dilatation adjacent to the ablation zone was found in one case (in the late subacute phase [n=1]), infarction adjacent to the ablation zone was found in three cases (in the early subacute [n=2] and late subacute [n=1] phases). None of the above changes was found in the livers ablated without the Pringle maneuver. On the microscopic findings, centrilobular congestion, sinusoidal congestion, sinusoidal platelet and neutrophilic adhesion, and hepatocyte vacuolar and ballooning changes in liver ablated with Pringle maneuver showed more significant changes than in those livers ablated without the Pringle maneuver (p < 0.05) Conclusion Radiofrequency ablation with the Pringle maneuver created more severe pathologic changes in the portal vein, bile ducts and liver parenchyma surrounding the ablation zone compared with RF ablation without the Pringle maneuver. Therefore, we suggest that RF ablation with the Pringle maneuver should be performed with great caution in order to avoid unwanted thermal injury.

[1]  F. Guillemin,et al.  Biliary Lesions during Radiofrequency Ablation in Liver , 2004, European Surgical Research.

[2]  Julian A. Smith Sabiston. Textbook of Surgery: The Biological Basis of Modern Surgical Practice , 2002 .

[3]  D. Choi,et al.  Hepatocellular carcinoma treated with percutaneous radio-frequency ablation: evaluation with follow-up multiphase helical CT. , 2001, Radiology.

[4]  L Solbiati,et al.  Essential techniques for successful radio-frequency thermal ablation of malignant hepatic tumors. , 2001, Radiographics : a review publication of the Radiological Society of North America, Inc.

[5]  T. Baère,et al.  Radio-frequency tissue ablation of the liver: effects of vascular occlusion on lesion diameter and biliary and portal damages in a pig model , 2001, European Radiology.

[6]  A. M. Cotlar Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice , 2001 .

[7]  T. Winter,et al.  Effect of vascular occlusion on radiofrequency ablation of the liver: results in a porcine model. , 2001, AJR. American journal of roentgenology.

[8]  J S Lewin,et al.  How does alteration of hepatic blood flow affect liver perfusion and radiofrequency‐induced thermal lesion size in rabbit liver? , 2001, Journal of magnetic resonance imaging : JMRI.

[9]  H. Lim Radiofrequency Thermal Ablation of Hepatocellular Carcinomas , 2000, Korean journal of radiology.

[10]  D. Lu,et al.  Creation of radiofrequency lesions in a porcine model: correlation with sonography, CT, and histopathology. , 2000, AJR. American journal of roentgenology.

[11]  C Bartolozzi,et al.  Percutaneous radio-frequency thermal ablation of nonresectable hepatocellular carcinoma after occlusion of tumor blood supply. , 2000, Radiology.

[12]  G. Gazelle,et al.  Hepatocellular carcinoma: radio-frequency ablation of medium and large lesions. , 2000, Radiology.

[13]  G. Gazelle,et al.  Thermal ablation therapy for focal malignancy: a unified approach to underlying principles, techniques, and diagnostic imaging guidance. , 2000, AJR. American journal of roentgenology.

[14]  G S Gazelle,et al.  Radio-frequency-induced coagulation necrosis in rabbits: immediate detection at US with a synthetic microsphere contrast agent. , 1999, Radiology.

[15]  T. Livraghi,et al.  Small hepatocellular carcinoma treated with percutaneous RF ablation: MR imaging follow-up. , 1999, AJR. American journal of roentgenology.

[16]  L. Ellis,et al.  Radiofrequency Ablation of Unresectable Primary and Metastatic Hepatic Malignancies: Results in 123 Patients , 1999 .

[17]  L Solbiati,et al.  Radio-frequency ablation of hepatic metastases: postprocedural assessment with a US microbubble contrast agent--early experience. , 1999, Radiology.

[18]  K. Man,et al.  Tolerance of the liver to intermittent pringle maneuver in hepatectomy for liver tumors. , 1999, Archives of surgery.

[19]  E. Patterson,et al.  Radiofrequency ablation followed by resection of malignant liver tumors. , 1999, American journal of surgery.

[20]  N. Habib,et al.  Clinical short-term results of radiofrequency ablation in primary and secondary liver tumors. , 1999, American journal of surgery.

[21]  R. Lencioni,et al.  Relationship between the shape and size of radiofrequency induced thermal lesions and hepatic vascularization. , 1999, Tumori.

[22]  E. Patterson,et al.  Radiofrequency ablation of porcine liver in vivo: effects of blood flow and treatment time on lesion size. , 1998, Annals of surgery.

[23]  L Solbiati,et al.  Ablation of liver tumors using percutaneous RF therapy. , 1998, AJR. American journal of roentgenology.

[24]  F. Garbagnati,et al.  Percutaneous treatment of small hepatic tumors by an expandable RF needle electrode. , 1998, AJR. American journal of roentgenology.

[25]  K. Man,et al.  Prospective evaluation of Pringle maneuver in hepatectomy for liver tumors by a randomized study. , 1997, Annals of surgery.

[26]  L Solbiati,et al.  Hepatic metastases: percutaneous radio-frequency ablation with cooled-tip electrodes. , 1997, Radiology.

[27]  F. Garbagnati,et al.  Percutaneous RF interstitial thermal ablation in the treatment of hepatic cancer. , 1996, AJR. American journal of roentgenology.

[28]  J. McGahan,et al.  Hepatic ablation with use of radio-frequency electrocautery in the animal model. , 1992, Journal of vascular and interventional radiology : JVIR.

[29]  J. McGahan,et al.  Radiofrequency ablation of the liver: current status. , 2001, AJR. American journal of roentgenology.

[30]  W R Lees,et al.  Minimally invasive treatment of malignant hepatic tumors: at the threshold of a major breakthrough. , 2000, Radiographics : a review publication of the Radiological Society of North America, Inc.

[31]  L Solbiati,et al.  Saline-enhanced radio-frequency tissue ablation in the treatment of liver metastases. , 1997, Radiology.

[32]  R Fiocca,et al.  Percutaneous US-guided radio-frequency tissue ablation of liver metastases: treatment and follow-up in 16 patients. , 1997, Radiology.

[33]  Bourgeon,et al.  [Liver and the biliary tract]. , 1955, Afrique francaise chirurgicale.