How I do it: Safe placement of large cryoprobes during cryosurgery of deep liver metastases
✍ Scribed by Rivoire, Michel L.; Kaemmerlen, Pierre; Molina, Guillermo
- Publisher
- John Wiley and Sons
- Year
- 1996
- Tongue
- English
- Weight
- 111 KB
- Volume
- 63
- Category
- Article
- ISSN
- 0022-4790
No coin nor oath required. For personal study only.
✦ Synopsis
Cryosurgery of liver metastases can be a curative treatment in patients unable to undergo hepatic reason [ I , 21. Hemorrhage is the major cause of mortality or the main indication for re-operation, specially when treating large, deep, central metastases [3,4]. We describe here a simple, reliable technique for ultrasound-guided intrahepatic placement of a large cryoprobe.
After full liver mobilization, unresectable deep metastases are mapped out by intraoperative ultrasound. An echogenic 16-gauge needle is inserted through the metastasis under ultrasound guidance. Its mandrel is removed, a guidewire is inserted, and the needle is withdrawn. Dilatation from 8-F to 30-F is performed using a telescopic set of nine metal dilators specially designed for nephrostomy (Olympus@, Hamburg, Germany) (Fig. ). The first 8-F dilator is inserted over the guidewire through both the normal liver and the tumor. Larger dilators are then gradually inserted to enlarge the channel to 30-F. A 32-F Teflon sheath is inserted over the last dilator (Fig. ). The dilators and the guidewire are removed, a 1-cm