Οriginal Paper 2359 LIVER Hepato-Gastroenterology 2014; 61:2359-2366 doi 10.5754/hge13987 © H.G.E. Update Medical Publishing S.A., Athens-Stuttgart Key Words: Laparoscopic liver resection; Radiofrequency; Hand-assisted; Liver cancer. Abbreviations: Hepatocellular carcinoma (HCC); Laparoscopic liver resection (LLR); Liver resection (ORL); Radiofre- quency (RF). Background/Aims: After the first reported laparo- scopic liver resection (LLR) twenty years ago, liver surgery still remains one of the last areas of resis- tance to the offensive of laparoscopy. Radiofrequency assisted laparoscopic liver resection has been recently developed technique for treatment of primary and secondary liver tumors. Methodology: Over a 5-year period, a total of 134 laparoscopic and open radiofrequency assisted operations were per- formed in a single institution. LLR was done in 47 pa- tients, and open liver resection (OLR) in 87 patients. Results: The study selection criteria were fulfilled by 134 patients. The mean blood loss for LLR was 68.7mL, the difference between the groups was significant with lower median of blood loss using laparoscopy (p=0.046). The mean of length of hospital stay in LLR was 7.5 days versus 8.7 days in OLR (p=0.071). The 5- year survival rate was 67.0% after LLR and 63.8% after OLR. The 5- year disease-free survival rate was 59.4% after LLR, and 62.2% after OLR. The difference between groups was not statistically significant. Conclusions: Laparoscopic liver resection is safe and feasible procedure. The hand-assisted laparoscopic radiofrequency technique can be applied effectively for selected patients. Preliminary oncological results suggest non-inferiority of laparoscopic to open proce- dures. ABSTRACT Radiofrequency-Assisted Liver Resections: Comparison of Open and Laparoscopic Techniques Vavra Petr 1,2,3,5 , Nowakova Jana 3 , Jelinek Petr 1 , Hasal Martin 3 , Penhaker Marek 3 , Ihnat Peter 1,2 , Jurcikova Jana 4 , Habib Nagy 5 and Zonca Pavel 1,2 1 Department of Surgery, University Hospital Ostrava, the Czech Republic 2 Faculty of Medicine, University of Ostrava, the Czech Republic 3 Faculty of Electrical Engineering and Computer Science VŠB - Technical University of Ostrava, the Czech Republic 4 Department of Vice-President for Science and Research, University Hospital Ostrava, the Czech Republic 5 Department of Liver and Pancreas Surgery, Hammersmith Hospital, Imperial College London, United Kingdom Corresponding author: Jana Nowakova, 17 Listopadu 15/2172, 708 33 Ostrava – Poruba, Czech Republic; Tel.: +420 732 682 205; E-mail: jana.nowakova@vsb.cz INTRODUCTION Experimental use of radiofrequency (RF) ablation in liver tumours was pioneered by Italian oncologists who used RF to treat primary liver tumours. Rossi first used ultrasound-guided (USG) RF for ablation of intra parenchymatous liver lesions with minimal harm to the surrounding parenchyma (1). Based on this success, Karasawa et al. and Anzai et al. began using USG radio- frequency ablation as oncological therapy for tumours in other organs, including lung tumours, brain metas- tases, bone tumours, and prostate tumours (2-5). For more than a decade, RF devices have also been used for RF-assisted liver resection (‘Habib’s resection’). In this procedure, an RF probe is used to coagulate the liver pa- renchyma to create a plane of coagulative necrosis along the line of the intended parenchymal transection. A spe- cial bipolar RF probe, termed the Habib 4X (Angiody- namics Inc., Queensbury, NY, USA), was developed to al- low quicker and safer RF-assisted liver resection (6), (7). Laparoscopic liver resection The first laparoscopic liver resection (LLR) for fo- cal nodular hyperplasia was reported by Gagner et al. in 1992 (8). The first successful laparoscopic ana- tomical hepatectomy was performed by Azagra et al. in 1993 and reported in 1996. Specifically, Azagra et al. performed a left lateral segmentectomy to remove liver segments 2 and 3 in a patient with a benign ade- noma (9). At that time, minimally invasive approaches had been introduced and used widely in other surgi- cal fields. However, the use of LLR in liver surgery was still very limited. This was because technical problems remained—elementary manoeuvres now used in open hepatic surgery, including manual palpation, organ mo- bilization, vascular control, and parenchymal transec- tion, had not been standardised, plus there were risks of uncontrolled haemorrhage and inadequate oncological radicality (10). Subsequently, several studies showed that the risk of haemorrhage was extremely low in clini- cal practice and that there was little risk of inadequate oncological radicality. Over time, the proper use of on- cological surgical principles reduced the risks to a level that was comparable to the risks of open surgery (10). In recent years, there has been increased patient de- mand for laparoscopic procedures. Advances in our un- derstanding of liver anatomy, developments in radiolog- ic imaging, and technological advances in laparoscopic devices have led to increases in the number of LLRs that are performed. Nowadays, more than 3,000 laparo- scopic liver resections have been performed worldwide,