Thermal Protection with 5% Dextrose Solution Blanket During Radiofrequency Ablation

Abstract

A serious complication for any thermal radiofrequency ablation is thermal injury to adjacent structures, particularly the bowel, which can result in additional major surgery or death. Several methods using air, gas, fluid, or thermometry to protect adjacent structures from thermal injury have been reported. In the cases presented in this report, 5% dextrose water (D5W) was instilled to prevent injury to the bowel and diaphragm during radiofrequency ablation. Creating an Insulating envelope or moving organs with D5W might reduce risk for complications such as bowel perforation. Keywords Radiofrequency ablationAlthough complication rates during hepatic radiofrequency ablation (RFA) are quite low, catastrophic damage to the bowel is possible, and injury to the diaphragm or thoraco-abdominal wall can result in substantial postprocedure pain. In RFA of focal hepatic cancers, gastrointestinal wall perforation resulting from thermal injury is seen in 0.7% of cases [1]. This serious complication could result in further major surgery or death. Several methods have been described to protect adjacent structures from thermal damage by displacing organs with gas, fluid, balloons, or the use of thermometry [2][3][4][5]. Targeted instillation of 5% dextrose water (D5W) solution might provide insulation to minimize injury to sensitive anatomy, such as the bowel or nerves. D5W might be more efficacious than normal saline because it not only mechanically forms a protective insulating envelope but also has less electrical conductivity than normal saline. Less conductivity might result in less heat transfer to surrounding tissues. Therefore, we chose to use D5W instead of normal saline for the cases described below. Case 1The patient was a 32-year-old female with metastatic adrenocortical carcinoma, first diagnosed 3 year prior to presentation, at which time she underwent resection of primary adrenal neoplasm. Lung and retroperitoneal metastases developed 5 months later and she has since been stabilized with slowly progressive disease on multiple chemotherapeutic regimens. Although her extrahepatic disease remained well controlled on chemotherapy, two liver metastases appeared 3 months prior to RFA and rapidly progressed with growth markedly outpacing extrahepatic sites. Concurrent right upper quadrant pain was present. Magnetic resonance (MR) scan pre-RFA showed two liver lesions: one left lobe measuring 5.9 × 5.6 cm and the one right lobe lesion measuring 4.2 × 2.7 cm and whose inferior aspect touched the colon (Fig. 1A,B).Written informed consent was obtained and RFA was performed on an investigational reviewboard-approved study. Under general anesthesia and prior to RFA, a 22-gauge Chiba needle was inserted percutaneously under continuous ultrasound guidance in a lower intercostal space near the midaxillary line. The needle was placed at the liver capsule lateral to the right lobe. Thirty cubic centimeters of D5W was injected at the capsule until a target was seen on ultrasound for subsequent deployment of a side-hole s...

Using an electrode as a lever to increase the distance between renal cell carcinoma and bowel during CT-guided radiofrequency ablation

“…Hydrodissection between the RCC and bowel has been reported to prevent thermal injury by blocking the heat conductance during RFA or cryoablation of a RCC [1,3,5,9]. Kam et al [4] reported that CO 2 instillation and balloon interposition are also useful for protecting the organs adjacent to the RCC from thermal injury.…”

“…Bowel perforation has been reported to occur after RFA of liver tumors, leading to serious complications such as abscess formation and sepsis [2]. In order to prevent this complication, imaging-guided instillation of sterile water, 5% dextrose and CO 2 and balloon distraction have been used to increase the distance between the RCC and bowel [3][4][5]. However, these procedures may not only delay RFA but also increase the level of radiation exposure when computed tomography (CT) is the guiding modality.…”

Design and validation of a thermoreversible material for percutaneous tissue hydrodissection

“…As a result, a relatively large amount of liquid (1-3 L) or continuous infusion is often necessary to ensure adequate protection which can result in patient discomfort following the procedure. 6,[17][18][19][20][21][22][23] We evaluated the feasibility of an alternative to conventional liquids: an aqueous poloxamer 407 (P407) hydrodissection material. Poloxamers are polyethylene oxidepolypropylene oxide-polyethylene oxide (PEO-PPO-PEO) triblock copolymers that traditionally serve as nonionic surfactants.…”

Needlescopic ablation of small adrenal masses

“…Therefore, CT guidance is mandatory for left-sided lesions. Displacement of surrounding organs with D 5 W or CO 2 has been described and is a technical point that can make adrenal RFA safer and easier to perform [7,8].…”