Two cases of hepatocellular carcinoma located adjacent to the Glisson's capsule treated by laparoscopic radiofrequency ablation with intraductal chilled saline perfusion through an endoscopic nasobiliary drainage tube.

Radiofrequency ablation (RFA) is a commonly used local therapy for hepatocellular carcinoma (HCC). However, for tumors located adjacent to the Glisson's capsule in the hepatic hilar region, RFA may cause bile duct injury and may be difficult to perform using the standard procedure. We describe 2 HCC cases in which RFA was performed laparoscopically under general anesthesia while cooling bile ducts to prevent bile duct injury. An endoscopic nasobiliary drainage tube was preoperatively inserted, through which chilled saline was rapidly infused during laparoscopic RFA for HCC adjacent to the Glisson's capsule in the hepatic hilar region. The patient was discharged from hospital without intraoperative or postoperative complications. Follow-up contrast-enhanced CT revealed complete tumor cauterization and no evidence of late bile duct stenosis. This procedure is performed under general anesthesia and, unlike those performed under local anesthesia, is associated with minimal stress to patients and minimal risk of bile duct injury.