Which liver tumors undergoing radiofrequency ablation are more deserving of the laparoscopic route?

With the awareness of the efficacy, minimally invasiveness and safety of radiofrequency ablation for the treatment of liver tumors, the application of radiofrequency ablation, a modern technique for the treatment of liver tumors, is becoming more and more popular. As we all know, there are three paths to implement RF ablation therapy: one is the transcutaneous puncture path. Under the guidance of CT or ultrasound and other imaging devices, the RF needle is punctured into the liver tumor through the skin and liver. The advantage of this route is that it is relatively simple to carry out, and the specialty of the physician is not restricted, which can be a surgeon, an interventionalist or an imaging physician; the disadvantage is that there is a lack of intuitive judgment on the efficacy of ablation, and it is prone to produce collateral damage to perihepatic organs. The second is the laparoscopic route. It is to perform radiofrequency ablation of tumors under direct vision with the help of laparoscopic technology, which is suitable for subperitoneal tumors located in the periphery of the liver, especially for those who are closely related to the diaphragm, gastrointestinal, and gallbladder. The advantage is that it can avoid the side damage to gastrointestinal, diaphragm, heart, gallbladder and other important organs, the judgment of ablation scope is more accurate, the judgment of efficacy is more intuitive, and there is better ablation efficacy; the disadvantage is that it needs to be carried out by a surgeon under laparoscopy, and the non-surgeon is limited to carry out the procedure. The third is the open abdominal route. Radiofrequency ablation is performed in an open abdomen. The advantage is that it can effectively separate the tissues around the tumor to maximize the exposure of the tumor; the disadvantage is that the surgery is traumatic and the postoperative recovery is slow. This pathway is now less used. Through the above analysis, it is easy to see that the transcutaneous puncture path is suitable for small intrahepatic tumors; for subperitoneal tumors located in the periphery of the liver, because of the close relationship with the diaphragm, gastrointestinal and gallbladder locations, the choice of the transcutaneous puncture path is prone to cause complications such as diaphragm thermal injury or perforation, gastrointestinal perforation, gallbladder perforation, pericardial tamponade and so forth, and it is appropriate to prefer the laparoscopic path. In addition, from the perspective of long-term efficacy, the laparoscopic route is also preferred for subperitoneal tumors located in the hepatic periphery, because a large number of data have shown that compared with the percutaneous puncture route, the laparoscopic route can achieve a higher rate of complete ablation and long-term efficacy.