Resection of the caudate lobe of the liver is technically demanding, with the disparate goals of preserving major vascular and biliary structures without compromising tumor clearance.
In all 48 of the IRE procedures the tumors were located in close proximity to major vascular or biliary structures or to adjacent organs.
Technical unresectability was defined as the inability to completely resect all metastases while leaving at least 30% of normal liver parenchyma, resulting from a multinodular tumor distribution, large tumor size, or a close relationship with major vascular or biliary structures.
Notably, after IRE the extracellular matrix is left intact, which allows for the preservation of blood vessels and bile ducts [ 11]; this quality makes IRE an attractive adjunctive treatment in the management of tumors abutting major vascular and biliary structures by limiting collateral damage done to these critical structures during ablation.
Currently it appears that the role of IRE will be for local ablation of unresectable masses adjacent to major vascular or biliary structures or for margin ablation to facilitate extended resections, and at the present time IRE will not replace the need for systemic neoadjuvant or adjuvant chemotherapy.
By using IOC as a road map of the biliary system, the surgeon can theoretically confirm the adequacy of the operative dissection, clarify assumptions made about the anatomy, and identify the location of the CBD before division of any biliary structures that could potentially help avoid major injury.
The main advantages shown in old patients were: the possibility to extend major liver resections while calculating exactly the rest-volume of the liver, to give a more precise localization of vessels and biliary structures, to allow the recognition of anatomical variants, to drive multiple resection sparing as more parenchyma as possible avoiding re-resection.
Biliary structures proliferate without connection to the adjacent biliary tree.
5α-Cyprinol 27-sulfate is the major biliary bile salt present in cypriniform fish including the zebrafish (Danio rerio).
It produces controlled RF energy between the electrodes and the heat produced seals even major biliary and blood vessels and enables resection of the liver parenchyma with a scalpel without blood loss or biliary leak.
