Introduction: The management of giant liver hemangiomas remains controversial because of their benign nature, the unclear risk of developing complications and the relatively high morbidity and mortality associated with surgical resection. New therapeutic modalities for liver malignancies, such as radiofrequency ablation, may be useful to treat these tumors in a minimally invasive fashion. We present a patient with a giant hepatic hemangioma successfully treated with laparoscopic ultrasound-guided multipolar radiofrequency ablation.
Case Report: A 38 year-old male patient who had been complaining of constant pain in his right upper quadrant for over 1 year and diagnosed with a cavernous hemangioma on an abdominal ultrasound, was referred for evaluation. A 7.5 cm hypervascular tumor in segments V-VI of the liver, near the gallbladder, was confirmed on abdominal CT scanning. The patient was informed of the different alternatives and chose to undergo a minimally invasive treatment. Under general anesthesia, the patient was placed in the French position for laparoscopic cholecystectomy. Laparoscopic ultrasound scanning confirmed the presence of a giant hemangioma occupying part of segments V and VI and adjacent to the gallbladder, After performing a laparoscopic cholycystectomy, six T40 needles of the bipolar Celon Power System (Celon AG medical instruments Olympus, Germany)were percutaneously inserted into the abdomen under direct laparoscopic control and into the tumor under ultrasound guidance. Radiofrequency energy was delivered with an initial power setting of 40 watts and subsequently increased until reaching a power of 250 watts at 470 Hz. Tissue impedance was continuously monitored by the generator. The effect of radiofrequency on the hemangioma was imaged on real time. After completing tumor ablation, the needles were slowly withdrawn while ablating the tract in the liver. No intraoperative complications occurred. The patient remained asymptomatic in the immediate postoperative period and was discharged on postoperative day 2. A follow-up CT scan obtained 3 months after the procedure showed complete ablation of the lesion without residual enhancement. The lesion was completely replaced by hypodense material.
Summary: Radiofrequency ablation is a safe and effective treatment for giant liver hemangiomas. The laparoscopic approach combined with intraoperative ultrasonographic imaging may become a sound minimally invasive option for symptomatic patients.