One-lung ventilation for percutaneous thermal ablation of liver tumors in the hepatic dome

Abstract

Purpose: To investigate the feasibility, efficacy and safety of one-lung ventilation for percutaneous thermal ablation of liver tumors in the hepatic dome. Materials and methods: From 5 January 2017 to 16 April 2019, 64 patients who underwent ultrasound-guided thermal ablation with a total of 75 liver malignant tumors located in the hepatic dome were enrolled in the present study. One-lung ventilation was employed to improve the acoustic window and protect the lung and diaphragm. If the one-lung ventilation was unsuccessful, artificial pleural effusion was added. The technical efficacy was confirmed by contrast-enhanced computed tomography/magnetic resonance imaging (CT/MRI) 1 month later. After that, CT/MRI was performed every 3-6 months. Results: Among the enrolled patients, the technical success rate of one lung ventilation was 92.2% (59/64). The visibility scores of tumors were improved significantly after one-lung ventilation compared to those before one-lung ventilation (p < .001). Finally, 78.6% (55/70) of the tumors achieved clinical success of one-lung ventilation to become clearly visible and underwent thermal ablation. Fourteen of the remaining 15 tumors achieved a satisfactory acoustic window after combination of artificial pleural effusion. One lesion remained inconspicuous and partly affected by pulmonary gas. The follow-up period was 8 months (3-30 months). The technical efficacy rate was confirmed to be 100% (75/75). During the follow-up period, local tumor progression occurred in 2 patients (2/75, 2.7%). Major complications occurred in two patients (2/64, 3.1%) receiving one-lung ventilation. Conclusions: One-lung ventilation is a promising noninvasive method for the thermal ablation of hepatic dome tumors due to its efficacy and safety.

An ultrasonically actuated fine-needle creates cavitation in bovine liver

“…The advantage of employing a hypodermic needle as a waveguide to deliver the acoustic energy to the target is that acoustic streaming can be generated to treat lesions within anatomical regions, such as in the lungs or in the liver, that would be difficult to reach with conventional HIFU based systems. The complication arising from using HIFU to treat lesions within the thoracic region or in the hepatic dome, for example, is mainly associated with the acoustic shadowing of bones and gas, which can hinder the formation of a proper US focus at the target [113,114]. By using an ultrasonic needle for the local administration of drugs, not only these anatomical structures could be easily bypassed, but also one could avoid side effects and complications associated with other commonly used routes of drug administration (e.g., intravenous injection, systemic administration) [115,116,117,118] and minimize side bioeffects [114,119] along the beam path that one could observe in HIU applications.…”

An ultrasonically actuated needle promotes the transport of nanoparticles and fluids

“…However, this procedure is highly invasive, risky, and can lead to complications, thus it requires an experienced operator. 18 Also, the reflected acoustic energy may cause skin burns if uncontrolled, 19 for which reason the invasive procedure of partial rib resection has even been recently proposed and evaluated as a way to create an acoustic pathway for HIFU treatments. 18 Moreover, the translation of organs during breathing cycles can impact the precision, safety, and efficiency of the HIFU treatment methods.…”

Microwave ablation of colorectal liver metastases adjacent to the cardiophrenic angle: Parallel versus non-parallel placement of the antenna relative to the diaphragm

“…Previous studies have shown that thermal ablation of liver lesions adjacent to the diaphragm is related to rare diaphragmatic hernias, increased local tumor progression (LTP) rate, and post-procedural pain 7 , 8 . Several measures have been proposed to prevent these unfavorable results, including artificial ascites, 9 one-lung ventilation, 10 and intra-abdominal carbon dioxide insufflation. 11 …”