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Background: Liver resection (LR) and radiofrequency ablation (RFA) are curative-intent therapies for early stages of hepatocellular carcinoma (HCC). If HCC recurs, salvage liver transplant (SLT) may constitute a treatment option., Objective: We aimed to compare the outcomes of patients transplanted for recurrent HCC after curative-intent therapies with those transplanted as initial therapy., Methods: We conducted a matched-control (1:1) cohort study comparing patients with HCC treated with primary liver transplant (PLT) with SLT after HCC recurrence. Matching was performed according to the size and number of viable tumors at explant pathology following liver transplant., Results: Between November 1999 and December 2014, 687 patients with HCC were listed for transplant at our institution. A total of 559 patients were transplanted; 509 patients were treated with PLT and 50 patients were treated with SLT for HCC recurrence after primary treatment with LR (n = 25) or RFA (n = 25). The median length of follow-up from transplant was 64 months (0.5-195), and the median time from curative-intent treatment of HCC with RFA or LR to recurrence was 9.5 months (1-36) and 14.5 months (3-143), respectively (p = 0.04). The matched cohort was composed of 48 SLT patients (23 LR and 25 RFA) and 48 PLT patients. The 5-year risk of recurrence after LT was 22% in the PLT group versus 32% in the SLT group (p = 0.53), while the 5-year actuarial patient survival after PLT was 69% versus 70% in the SLT group (p = 1)., Conclusion: Liver transplant is an effective treatment for patients with HCC recurrence following RFA or LR. Outcomes are similar in both groups.

Background: As laparoscopic surgical procedures increase in complexity, surgeons may find themselves with the laparoscope opposite to their laparoscopic instruments, thus creating the paradoxical viewpoint. We assessed whether surgical task performance in the paradoxical viewpoint would be improved by digitally altering the image or by changing the camera orientation., Methods: Sixty-one laparoscopically naïve operators performed a Peg Transfer task using a trainer box. In the first "round," naïve operators were block-randomized to perform the Peg-Transfer task either in the standard view or the paradoxical view. In the second "round," naïve operators were positioned in the paradoxical view and block-randomized to having the monitor image as paradoxical (n = 19) or altered by being digitally flipped (mirror-image) (n = 22) or inverted (n = 20). The task consisted of transferring six plastic objects in 5 min (300 s). Scoring was based on the formula of total time = time to completion (max = 300 s) + penalty time (50 s/peg not transferred)., Results: In the first round, average total time to perform the Peg Transfer task using the standard view was 215 ± 20 s, which was significantly less (P < 0.001) than the 563 ± 13 s for the paradoxical view. In the second round (with all naïve operators in the paradoxical viewpoint), the total time for the paradoxical image, digitally flipped image (mirror-image), and inverted image were 561 ± 12, 449 ± 25, and 259 ± 37 s, respectively. The total time for the inverted image was significantly less than both the paradoxical image and digitally flipped image (P < 0.001). The total time for the digitally flipped image was also less than paradoxical image (P < 0.05). The group with the paradoxical image completed 0.8 ± 0.2 peg transfers, which was less than both the digitally flipped and inverted-view groups (P < 0.05)., Conclusions: This is the first study to demonstrate that when in the paradoxical viewpoint, altering the image on the video monitor, either by digitally flipping or inverting the image, can improve surgical task performance.