New Minimally Invasive Techniques in the Treatment of Patients with Lesions in the Liver: Laparoscopy and Extracorporeal High Intensity Focused Ultrasound
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AbstractLaparoscopic liver resection has shown classical advantages of minimally invasive surgery over the open counterpart. In spite of introduction in early 1990-s only few centres worldwide adapted laparoscopic liver resection to routine practice. It was due to considerable technical challenges and uncertainty about oncologic outcomes. Various ablative techniques have been developed last 2 decades in parallel with laparoscopy. High intensity focused ultrasound (HIFU) attracts special interests due to its fully non-invasive nature.
The main goal of this thesis was to estimate and develop new minimally invasive techniques in the treatment of patients with lesions in the liver: laparoscopic surgery and HIFU.
Two hundred and twenty patients, who underwent laparoscopic liver resection during 244 procedures from August 1998 to December 2010 at the Oslo University Hospital, Rikshospitalet, formed the research basis for the clinical section of this thesis.
An experimental porcine model was applied to study HIFU.
The study revealed lower complication rate and shorter postoperative hospital stay after laparoscopic procedures compared with rates typical for conventional open surgery. However, favourite oncologic outcomes after laparoscopic liver resection, 51% of 5-year overall survival and 42% of 5-ear disease-free survival, were most important outcome of this thesis.
The dissertation also proved both feasibility and efficiency of repeat liver resection. Effective technical solutions in regard to so-called difficult posterosuperior segments represented another secondary point of this thesis.
The experimental section of the dissertation defined challenging points of HIFU techniques in regard to liver lesions and suggested efficient solutions to overcome them.
List of papers. Papers I, II, III and V are removed from the thesis due to publisher restrictions.
Paper I: Kazaryan AM, Marangos IP, Rosseland AR, Røsok BI, Mala T, Villanger O, Mathisen Ø, Giercksky K.E, Edwin B. Laparoscopic liver resection for malignant and benign lesions: 10 year Norwegian single centre experience. Arch Surg. 2010; 145(1): 34-40 doi:10.1001/archsurg.2009.229
Paper II: Kazaryan AM, Marangos IP, Røsok BI, Rosseland AR, Villanger O, Fosse E, Mathisen Ø, Edwin B. Laparoscopic resection of colorectal liver metastases: surgical and long term oncologic outcome. Ann Surg. 2010; 252(6): 1005-1012 doi:10.1097/SLA.0b013e3181f66954
Paper III: Shafaee Z, Kazaryan AM, Marvin M, Cannon R, Buell JF, Edwin B, Gayet B. Is Laparoscopic Repeat Hepatectomy Feasible? A Tri-institutional Analysis. J Am Coll Surg 2011; 212(2):171-9 doi:10.1016/j.jamcollsurg.2010.10.012
Paper IV: Kazaryan AM, Røsok BI, Marangos IP, Rosseland AR, Edwin B. Comparative evaluation of laparoscopic liver resection for posterosuperior and anterolateral segments. Surg. Endosc. 2011; 25(12):3881-9 doi:10.1007/s00464-011-1815-x This article is published with open access at Springerlink.com
Paper V: Courivaud F, Kazaryan AM, Lund A, Pavlik Marangos I, Jebsen P, Fosse E, Hol PK, Edwin B. Acute and survival studies of magnet resonance guided high intensity focused ultrasound ablation in the swine liver. Submitted.