[Pneumothorax during laparoscopic percutaneous transthoracic radiofrequency ablation for liver tumors of the hepatic dome: a case report].

A 69-year-old man with hepatoma was scheduled for laparoscopic percutaneous transthoracic radiofrequency ablation (RFA) under general anesthesia. His history and physical examination were unremarkable. Anesthesia was induced with propofol and maintained with oxygen-air, sevoflurane and fentanyl. After pneumoperitoneum was introduced, percutaneous RFA needle was inserted into the hepatoma crossing the thoracic cavity and diaphragm several times. Sixty-five minutes after the start of pneumoperitoneum, breathing sounds gradually decreased over the right side of the chest. Because his oxygenation and hemodynamics were stable, the operation was continued with pneumoperitoneum. At the end of surgery, breathing sounds were hardly audible over the right side of the chest. Postoperative chest X-ray showed right pneumothorax. Following thoracentesis, the patient was successfully extubated. During laparoscopic percutaneous transthoracic radiofrequency ablation for liver tumors in the hepatic dome, pneumothorax can occur easily due to passage of peritoneal gas through lesion of the diaphragm caused by RFA needle. We anesthesiologist should recognize the risk of this operation.