Bowel Displacement for CT-Guided Tumor Radiofrequency Ablation: Techniques and Anatomic Considerations

Ginat, Daniel Thomas; Saad, Wael E.A.; Davies, Mark G.; Walman, David; Ertürk, Erdal

doi:10.1089/end.2008.0668

Cited by 27 publications

(16 citation statements)

References 18 publications

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“…Percutaneous hydro/ gas dissection is a simple and very effective technique and should be part of the routine armamentarium of any ablation practice [55][56][57]. Consensus level: strong As size, number and location are all important features, there is a strong consensus that these three factors should be considered in concert when evaluating the appropriateness of ablation in any given patient.…”

Section: Proximity To Vulnerable Structuresmentioning

confidence: 99%

Thermal ablation of colorectal liver metastases: a position paper by an international panel of ablation experts, the interventional oncology sans frontières meeting 2013

et al. 2015

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Objectives Previous attempts at meta-analysis and systematic review have not provided clear recommendations for the clinical application of thermal ablation in metastatic colorectal cancer. Many authors believe that the probability of gathering randomised controlled trial (RCT) data is low. Our aim is to provide a consensus document making recommendations on the appropriate application of thermal ablation in patients with colorectal liver metastases. Methods This consensus paper was discussed by an expert panel at The Interventional Oncology Sans Frontières 2013. A literature review was presented. Tumour characteristics, ablation technique and different clinical applications were considered and the level of consensus was documented.Eur Radiol (2015) Results Specific recommendations are made with regard to metastasis size, number, and location and ablation technique. Mean 31 % 5-year survival post-ablation in selected patients has resulted in acceptance of this therapy for those with technically inoperable but limited liver disease and those with limited liver reserve or co-morbidities that render them inoperable.Conclusions In the absence of RCT data, it is our aim that this consensus document will facilitate judicious selection of the patients most likely to benefit from thermal ablation and provide a unified interventional oncological perspective for the use of this technology. Key Points• Best results require due consideration of tumour size, number, volume and location.• Ablation technology, imaging guidance and intraprocedural imaging assessment must be optimised.• Accepted applications include inoperable disease due to tumour distribution or inadequate liver reserve.• Other current indications include concurrent co-morbidity, patient choice and the test-of-time approach.• Future applications may include resectable disease, e.g. for small solitary tumours.

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Section: Proximity To Vulnerable Structuresmentioning

confidence: 99%

Thermal ablation of colorectal liver metastases: a position paper by an international panel of ablation experts, the interventional oncology sans frontières meeting 2013

et al. 2015

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“…However, despite refinements in ablation technology, a limitation in liver ablation is adjacent thermal injury when the target lesion is along the surface of the liver as demonstrated in these patients. Strategies have emerged to protect the surrounding tissues including fluid or gas displacement, balloon interposition, thermometry, and torqueing of tissue (4,5).…”

Section: Discussionmentioning

confidence: 99%

“…Follow-up contrastenhanced MRI (f) of the mass after ablation (arrow) demonstrates complete devascularization of the mass without injury to adjacent structure. that the instillation of fluid separated the liver from the gastrointestinal tract in 78% of cases (4,5). Most recently, reports have emerged using a hyaluronic acid gel in humans and thermoprotective gels in an animal model (7,8).…”

Section: Discussionmentioning

confidence: 99%

Fibrillar collagen injection for organ protection during thermal ablation of hepatic malignancies

Majdalany

Willatt²,

Srinivasa³

et al. 2017

Diagn Interv Radiol

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“…Some authors applied injection of normal air [44], while others reported the use of carbon dioxide (CO2) for organ displacement [45, 46]. CO2 seems to be particularly useful, as it is quickly reabsorbed by the body and eliminated by respiration.…”

Section: Gas Insufflationmentioning

confidence: 99%

Tips and tricks for a safe and effective image-guided percutaneous renal tumour ablation

et al. 2017

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Image-guide thermal ablations are nowadays increasingly used to provide a minimally invasive treatment to patients with renal tumours, with reported good clinical results and low complications rate. Different ablative techniques can be applied, each with some advantages and disadvantages according to the clinical situation. Moreover, percutaneous ablation of renal tumours might be complex in cases where there is limited access for image guidance or a close proximity to critical structures, which can be unintentionally injured during treatment. In the present paper we offer an overview of the most commonly used ablative techniques and of the most important manoeuvres that can be applied to enhance the safety and effectiveness of percutaneous image-guided renal ablation. Emphasis is given to the different technical aspects of cryoablation, radiofrequency ablation, and microwave ablation, on the ideal operating room setting, optimal image guidance, application of fusion imaging and virtual navigation, and contrast enhanced ultrasound in the guidance and monitoring of the procedure. Moreover, a series of protective manoeuvre that can be used to avoid damage to surrounding sensitive structures is presented. A selection of cases of image-guided thermal ablation of renal tumours in which the discussed technique were used is presented and illustrated.Teaching points• Cryoablation, radiofrequency and microwave ablation have different advantages and disadvantages. • US, CT, fusion imaging, and CEUS increase an effective image-guidance. • Different patient positioning and external compression may increase procedure feasibility. • Hydrodissection and gas insufflation are useful to displace surrounding critical structures. • Cold pyeloperfusion can reduce the thermal damage to the collecting system.

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Bowel Displacement for CT-Guided Tumor Radiofrequency Ablation: Techniques and Anatomic Considerations

Abstract: Lower pole, posterior renal lesions are more likely to necessitate bowel displacement. Bowel displacement techniques are effective and safe in displacing bowel.

Cited by 27 publications

References 18 publications

Thermal ablation of colorectal liver metastases: a position paper by an international panel of ablation experts, the interventional oncology sans frontières meeting 2013

Thermal ablation of colorectal liver metastases: a position paper by an international panel of ablation experts, the interventional oncology sans frontières meeting 2013

Fibrillar collagen injection for organ protection during thermal ablation of hepatic malignancies

Tips and tricks for a safe and effective image-guided percutaneous renal tumour ablation

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