Heung Kyu Ko

Efficacy of Prophylactic Uterine Artery Embolization before Obstetrical Procedures with High Risk for Massive Bleeding

Objective To evaluate the safety and efficacy of prophylactic uterine artery embolization (UAE) before obstetrical procedures with high risk for massive bleeding. Materials and Methods A retrospective review of 29 female patients who underwent prophylactic UAE from June 2009 to February 2014 was performed. Indications for prophylactic UAE were as follows: dilatation and curettage (D&C) associated with ectopic pregnancy (cesarean scar pregnancy, n = 9; cervical pregnancy, n = 6), termination of pregnancy with abnormal placentation (placenta previa, n = 8), D&C for retained placenta with vascularity (n = 5), and D&C for suspected gestational trophoblastic disease (n = 1). Their medical records were reviewed to evaluate the safety and efficacy of UAE. Results All women received successful bilateral prophylactic UAE followed by D&C with preservation of the uterus. In all patients, UAE followed by obstetrical procedure prevented significant vaginal bleeding on gynecologic examination. There was no major complication related to UAE. Vaginal spotting continued for 3 months in three cases. Although oligomenorrhea continued for six months in one patient, normal menstruation resumed in all patients afterwards. During follow-up, four had subsequent successful natural pregnancies. Spontaneous abortion occurred in one of them during the first trimester. Conclusion Prophylactic UAE before an obstetrical procedure in patients with high risk of bleeding or symptomatic bleeding may be a safe and effective way to manage or prevent serious bleeding, especially for women who wish to preserve their fertility.

Newly Designed Flexible Electrode for Laparoscopic Radiofrequency Ablation: Ex Vivo and In Vivo Comparative Studies with Needle Electrode in a Porcine Liver as Technical Study

BACKGROUNDnTo compare the efficiency of radiofrequency ablation (RFA) using the newly designed flexible laparoscopic radiofrequency electrode and the internally cooled needle electrode for creating an ablation zone in ex vivo and in vivo porcine livers.nnnMATERIALS AND METHODSnIn the ex vivo ablation zone, 40 ablation areas were created using the flexible electrode (group A, n=5) and the needle electrode of the Cool-tip RF system (group B, n=5). These were done in an excised porcine liver with a 200 W generator. In each group, ablation durations were 3, 6, 9, and 12 min, respectively. The volume was compared in each group. In the in vivo ablation zone, under laparoscopy, we divided the surface of the porcine liver into four areas: anterior, cranial, right lateral, and caudal. At each area, a couple of RFA using the flexible and needle electrodes with 6 min ablation duration was performed, respectively, in line with 3 cm intervals in five porcine livers. A flexible electrode was administered in the peritoneal cavity via a laparoscopic cannula, and a needle electrode was administered via a transcutaneous route, which avoided a pulmonary injury. The volumes and shapes of the ablation zones in each group and area were compared in the excised liver.nnnRESULTSnIn the ex vivo experiments, the ablation volumes using the flexible and needle electrodes with 3, 6, 9, and 12 min ablation duration were 3.19±0.41 cm(3), 6.36±0.48 cm(3), 7.66±0.51 cm(3), 8.72±0.78 cm(3) (Group A) and 3.40±0.35 cm(3), 6.83±0.66 cm(3), 7.79±0.56 cm(3), 8.85±0.54 cm(3) (Group B). There was no statistical significance among all the ablated volumes in each group at the same duration. In the in vivo experiment, the differences in the short diameter and the volume of ablated zones in the caudal and right lateral areas were statistically significant (P<0.05). In the cranial, right lateral, and caudal areas, the shape of the ablated zone using the needle electrode was elliptical. However, the ablated zone using the flexible electrode was spherical. The difference of the long and short diameter ratio in the cranial and right lateral areas was statistically significant (P<0.05).nnnCONCLUSIONnThe newly designed flexible laparoscopic RF electrode shows similar efficacies compared with the needle electrode in the ex vivo study. However, it shows superiority in efficacy and predictability with the increased volume and predictable shape of coagulation necrosis at the laparoscopic RFA in the porcine liver.

Ultrasound-Guided Intraoperative Radiofrequency Ablation and Surgical Resection for Liver Metastasis from Malignant Gastrointestinal Stromal Tumors

Objective To evaluate the effectiveness, safety, and feasibility of intraoperative radiofrequency ablation (IORFA) under ultrasound guidance for the treatment of liver metastases from gastrointestinal stromal tumors (GISTs). Materials and Methods From August 2009 to February 2017, 24 patients with liver metastases of GISTs underwent IORFA, 14 underwent concurrent IORFA and primary GIST resection, and 10 underwent IORFA to treat hepatic recurrence after previous primary GIST resection. Seventy-six hepatic metastases were treated, of which 47 were surgically resected and 29 underwent IORFA. All included patients received imatinib therapy as standard treatment before and after IORFA or surgical resection. A retrospective medical record review was conducted, and follow-up data were collected. Technical success and effectiveness, overall and GIST-specific survival, and complications were assessed. Results The mean follow-up duration was 50.7 ± 34.7 months. The technical success rate of IORFA was 100%. New metastases developed in three of the 24 patients (12.5%) following a complete response 16, 51, and 95 months after IORFA, respectively. The cumulative one-, three-, and five-year overall survival rates were 100, 94.4, and 87.7%, respectively. The one-, three-, and five-year GIST-related survival rates were 100, 94.4, and 94.4%, respectively. Two major complications (biliary stricture and hepatic abscess) were observed. Conclusion IORFA appears to be a feasible and safe treatment option for liver metastasis in patients with primary GISTs. In addition, IORFA and surgical resection may be complementary, helping to obtain complete response in cases of otherwise inoperable liver metastases secondary to GISTs.

Portal Vein Thrombosis after Endovascular Embolization of Splenic Artery for a Symptomatic Arterioportal Fistula: A Case Report and Literature Review

Arterioportal fistula (APF) can induce severe portal hypertension and therefore requires appropriate and timely management. Endovascular treatment is increasingly used for the treatment of APFs due to its minimally invasive nature, although this procedure can lead to potentially fatal portal vein thrombosis (PVT). Reports of this complication are, however, rare. Here, we describe the case of a 65-year-old woman who experienced an extensive thrombosis from the splenic vein to the right portal vein after embolization of a splenic APF, leading to the requirement for intensive care unit care and a prolonged hospital stay. In addition, the literature was reviewed to describe the clinical manifestations, diagnosis, and treatment of PVT after embolization of APF.

Experience at 1 year with the moving tip technique of radiofrequency ablation for the treatment of symptomatic venous malformations in the head and neck

PURPOSEnTo evaluate the effectiveness and safety of performing radiofrequency ablation (RFA) using the moving tip technique to treat venous malformations (VMs) in the head and neck.nnnMETHODSnTen patients (male:female ratio, 2:8; median age, 38xa0years; age range, 27-59 years) prospectively underwent RFA using the moving tip technique as the first treatment. Improvement of their clinical symptoms, volume reduction ofxa0the treated VMs as determined by ultrasound (US) or magnetic resonance imaging (MRI), and any patient complications were evaluated at 1, 3, 6, and 12 months after RFA.nnnRESULTSnAll patients underwent follow-up examinations 12xa0months after RFA. The following criteria were used to evaluate these patients: (1) symptomatic VMs were diagnosed by US, MRI, and the patients clinical history; (2) superficially located VMs were evaluated using a linear 12-MHz US probe to determine the tumor volume; and (3) localized and limited VMs were evaluated using the Hamburg classification. The mean symptom score of the 10-cm visual analog scale and the mean volume reduction of the VMs as measured by MRI at the 6-month follow-up examination were significantly decreased from 8.0 (range, 7.0-9.0) to 2.0 (range, 1.0-3.0) and from 18.8 (range, 8.3-28.2) cm(3) to 8.5 (range, 4.2-14.1) cm(3), respectively (Pxa0< .05). No major patient complications were noted.nnnCONCLUSIONSnRFA using the moving tip technique is an effective and safe method for treating localized VMs in the head and neck.