Adjunctive hydrodissection of the bare area of liver during percutaneous thermal ablation of sub-cardiac hepatic tumours
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PERSPECTIVE
Adjunctive hydrodissection of the bare area of liver during percutaneous thermal ablation of sub‑cardiac hepatic tumours Julien Garnon1,2 · Roberto Luigi Cazzato1 · Pierre Auloge1 · Nitin Ramamurthy3 · Guillaume Koch1 · Afshin Gangi1
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Objective To report the technique of hydrodissection of the sub-diaphragmatic bare area of the liver, in order to protect the diaphragm/heart during percutaneous thermal ablation (PTA) of sub-cardiac hepatic tumours. Materials and methods Between January 2016 and December 2018, five patients (four female, one male; mean age 56.2 years) with five sub-cardiac liver tumours (two hepatocellular carcinoma, three metastases; mean size 39 mm) abutting the bare area (segments II/IVA) with expected ablation zones ≤ 5 mm from the myocardium were treated with PTA and adjunctive hydrodissection. Time to perform hydrodissection, distance between superior hepatic and diaphragmatic/pericardial surfaces before and after hydrodissection, ablation efficacy, complications, and local tumour progression (LTP) at last imaging follow-up were recorded. Results Technical feasibility was 100%, with mean hydrodissection-volume of 126 ml (range 80–200 ml) and median hydrodissection-time of 9 min (range 8–45 min). Liver-diaphragmatic and liver-pericardial distance increased, respectively, from 2.4 mm (range 0–8 mm) to 10.8 mm (range 6–19 mm) and from 4 mm (range 1–10 mm) to 12.6 mm (range 8–20 mm) post-hydrodissection. All procedures were performed at full-power with complete tumour ablation and without complications (including peri-procedural haemodynamic/electrocardiographic disturbances, pericardial effusion and diaphragmatic hernia) or evidence of LTP at mean 12.2-month (range 1–26 month) follow-up. Conclusion Hydrodissection of the sub-diaphragmatic bare area of the liver is technically feasible and may potentially optimize safety PTA of sub-cardiac hepatic tumours. Keywords Bare area of the liver · Hydrodissection · Thermal ablation · Heart
* Julien Garnon [email protected] Roberto Luigi Cazzato [email protected] Pierre Auloge [email protected] Nitin Ramamurthy [email protected] Guillaume Koch [email protected] Afshin Gangi afshin.gangi@chru‑strasbourg.fr 1
Department of interventional radiology, Nouvel Hôpital Civil, 1, place de l’hôpital, 67096 Strasbourg Cedex, France
2
UMR 7357, CNRS, INSA Strasbourg, ICube - University of Strasbourg, 1 place de l’Hôpital, 67091 Strasbourg, France
3
Department of Radiology, Norfolk and Norwich University Hospital, Norwich, UK
Introduction Hydrodissection is a frequently utilized thermoprotective technique during percutaneous thermal ablation (PTA) procedures, which physically separates target lesions from adjacent structures, mitigating the risk of unintended collateral thermal damage [1]. For ablation of hepatic dome tumours, artificial ascites is typically employed to displace the diaphragm from the ablation-zone, and minimi
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