To evaluate the safety and efficacy of laparoscopic occlusion of the first porta hepatis in the microwave ablation of giant hepatic hemangioma.

Clinical data of 20 patients with giant hepatic hemangioma who underwent laparoscopic ultrasound-guided microwave ablation in the First People's Hospital of Yunnan Province from May 2018 to May 2020 were retrospectively analyzed. Among them, 8 patients were male and 12 female, aged 20-70 years, with a median age of 42 years. 5 patients were diagnosed with single onset of hemangioma, and 15 cases multiple onset. The tumor diameter was measured as 10-15 cm. The informed consents of all patients were obtained and the local ethical committee approval was received. Preoperatively, all patients received D visual reconstruction of the liver to determine the ablation plans. Intraoperatively, laparoscopic occlusion of the first porta hepatis was performed. Ultrasound-guided percutaneous microwave ablation of hepatic hemangioma was performed through abdominal wall. Postoperative CT scan was carried out. The ablation efficacy was evaluated by the Response Evaluation Criteria in Solid Tumor.

All patients successfully completed the surgery. No patient was converted to open surgery. The median number of occlusion of first porta hepatis was 2(1-3). The occlusion time was 24(15-45) min. The average ablation time was (26.4±2.7) min. Intraoperative blood loss was (16±6) ml. The length of postoperative hospital stay was 4(3-7) d. Hemoglobinuria occurred in 1 case and fever in 12 cases after surgery, and they were cured after symptomatic treatments. No severe complications, such as bleeding, bile leakage or adjacent organ injury, were reported. At postoperative 6 months, the complete remission rate of microwave ablation was 70%(14/20), 25%(5/20) for the partial remission rate and 95%(19/20) for the total remission rate.

For microwave ablation in treating giant hepatic hemangioma, laparoscopic occlusion of the first porta hepatis can reduce the heat sink effect produced by blood flow and yield favorable clinical efficacy, which has the advantages of minimal invasiveness and low incidence of complications.