A toroidal-shaped HIFU transducer generates large conical lesions. (a) Geometric focalization. (b) B-mode ultrasound image of the liver performed before HIFU exposures with the integrated sectorial ultrasound imaging probe (working frequency: 7.5 MHz, numerical image resolution: 5 pixels/mm). (c) Image of the liver 5 s after the end of the exposures. A cloud of ebullition appears momentarily (approximately during 1 min) at the location of the lesion. (d) High resolution image of a cone-shaped single HIFU lesion performed with a linear imaging probe (working frequency: 12 MHz, numerical image resolution: 10 pixels/mm). 5 min after the end of HIFU exposures, the single lesion appears on sonogram as a hyperechoic zone at its center and a hypoechoic zone at its boundaries. (e) View of gross sample of the coagulated conical zone in liver tissues.
Creation of a wall of necrosis on the resection line by juxtaposing single HIFU lesions.
Surgical hepatic resection assisted by HIFU. Resection of the right central lobe (HIFU group). (1) In situ view of the lobe after HIFU precoagulation. Macroscopic control of the precoagulation was possible since HIFU lesions were visible on the anterior surface of the lobe. (2) HIFU necrosis was also visible on the superior surface of the lobe. (3) Surgical resection of the lobe on the line of precoagulation by using the Kelly clamp crushing technique (kellyclasy). (4) Slice of resection on the remaining parenchyma after the end of the procedure.
(a) Resected lobes. (b) Percentage of resected lobe. (c) Resection slice on gross pathology at day 0 (HIFU group). (d) Average surface area of the resection slice in each group.
Vascular control during resection. (a) Average number of surgical clips used per surface unit and per resection. (b) Blood loss volume per surface unit and per resection.
Treatment time. (a) Procedure time for a one lobe resection. (b) Intrinsic resection time of one lobe.
Resection slice at day 14 on the remaining parenchyma (HIFU group). (a) View on gross pathology. (b) Microscopic view
Animal characteristics and resection parameters.
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