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

Abstract

The technique of using an electrode as a lever to increase the distance between renal cell carcinoma (RCC) and bowel during CT-guided radiofrequency ablation (RFA) is described. CT-guided percutaneous RFA was performed in two patients with two RCCs, which were in close proximity to the adjacent bowel. A sterile drape was placed on the electrode handle following appropriate electrode placement within the tumor in order to displace the kidney upward and to widen the distance to >5 mm between RCC and bowel (RCC-to-bowel distance). In patient 1, the RCC-to-bowel distance increased from 3 mm to 6 mm; in patient 2, from less than 2 mm to 6 mm. Follow-up CT performed 1 month after RFA demonstrated not only complete ablation of the two RCCs but also no thermal injury to the bowel adjacent to the tumors. In conclusion, an electrode might be used as a lever to increase RCC-to-bowel distance during CT-guided RFA by placing a sterile drape on it.

Complications of image-guided radiofrequency ablation of renal cell carcinoma: causes, imaging features and prevention methods

“…d Explolaparotomy performed 1 week after RF ablation of the right kidney shows no adhesion between the right kidney (RK) and the small (SB) or large (LB) bowel. Only a small haemorrhage (arrowheads) is noted on the surface of the right anterior renal fascia Noninvasive methods to prevent complications include changing the patient's position and using the electrode as a lever [11]. Most of all, position change is strongly recommended because this technique is easy to apply with no additional equipment or cost.…”

“…If perirenal space has enough fatty tissue, the renal tumour can be displaced. In patients with little fatty tissue, there is some limitation in using the electrode as a lever because the tumour can barely be moved [11].…”

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

“…These include hydrodissection, gas (CO 2 ) dissection, balloon catheter distraction, and electrode leveraging=torquing. [9][10][11][12][13][14][15][16] Hydrodissection has been implemented with satisfactory results using 5% dextrose in water solution 12,16 and water. 9,11 Similar to our own experience, bowel displacement and fluid instillation volumes of 2.1 to 2.5 cm for 135 to 150 mL were reported by Farrell and associates.…”

“…10 In contrast, interventional bowel displacement procedures enable RFA to be performed with satisfactory results, even when the bowel is initially contiguous with tumor. 9,[11][12][13][14][15][16] This study evaluates the effectiveness of bowel separation techniques during percutaneous CT-guided renal RFA and addresses anatomic factors that influence the need for these techniques.…”

Image-Guided Percutaneous Ablation of Renal Tumors

“…The probe can also be used as a lever to move the kidney away from adjacent structures (Park & Kim, 2008). If a transpleural approach is inevitable, it can be pursued and any pneumothorax that develops may be treated accordingly.…”