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Kapuria R, Wu H, Mubarak A, Freedman A, Elhelf IAS. Colon Deflation Using a Fine Needle as an Adjunct to Hydrodissection and Pneumodissection for Cryoablation of a Renal Mass. J Vasc Interv Radiol 2023; 34:1849-1851. [PMID: 37391070 DOI: 10.1016/j.jvir.2023.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/24/2023] [Accepted: 06/20/2023] [Indexed: 07/02/2023] Open
Affiliation(s)
- Rohan Kapuria
- Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Hanping Wu
- Department of Radiology and Imaging, Medical College of Georgia at Augusta University, Augusta, Georgia.
| | - Ahmad Mubarak
- Department of Radiology and Imaging, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Arthur Freedman
- Department of Radiology and Imaging, Medical College of Georgia at Augusta University, Augusta, Georgia
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Sharma Y, De U. Pneumodissection-Aided Laparoscopic Cholecystectomy (PDLC) Using Innovative Pneumodissector in a Resource-Limited Setting. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03109-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Tomita K, Iguchi T, Matsui Y, Uka M, Umakoshi N, Hiraki T. Pneumodissection during percutaneous renal cryoablation resulting in massive subcutaneous and mediastinal emphysema. Diagn Interv Imaging 2022; 103:231-232. [PMID: 34991992 DOI: 10.1016/j.diii.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/18/2021] [Accepted: 11/30/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Koji Tomita
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan.
| | - Toshihiro Iguchi
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan; Department of Radiological Technology, Okayama University Graduate School of Health Sciences, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan
| | - Yusuke Matsui
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan
| | - Mayu Uka
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan
| | - Noriyuki Umakoshi
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan
| | - Takao Hiraki
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan
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Seager M, Kumar S, Lim E, Munneke G, Bandula S, Walkden M. Renal cryoablation - a practical guide for interventional radiologists. Br J Radiol 2020; 94:20200854. [PMID: 32960674 DOI: 10.1259/bjr.20200854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Renal cryoablation is a treatment option for early stage renal cell carcinomas with excellent oncological outcomes and low morbidity. This review outlines the technique of renal cryoablation and provides a guide for interventional radiologists on setting up an integrated service within a renal cancer network multidisciplinary setting. Patient selection and preparation, together with the technical aspects which ensure optimal oncological outcomes and avoid collateral damage to adjacent organs are highlighted.
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Affiliation(s)
- Matthew Seager
- Interventional Oncology Service, University College Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom
| | - Shankar Kumar
- Interventional Oncology Service, University College Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom.,Centre for Medical Imaging, University College London, London, UK
| | - Emma Lim
- Interventional Oncology Service, University College Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom
| | - Graham Munneke
- Interventional Oncology Service, University College Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom
| | - Steve Bandula
- Interventional Oncology Service, University College Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom.,Centre for Medical Imaging, University College London, London, UK
| | - Miles Walkden
- Interventional Oncology Service, University College Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom
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Joe WB, Zarzour JG, Gunn AJ. Renal Cell Carcinoma Ablation: Preprocedural, Intraprocedural, and Postprocedural Imaging. Radiol Imaging Cancer 2019; 1:e190002. [PMID: 33778679 DOI: 10.1148/rycan.2019190002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 08/13/2019] [Accepted: 08/16/2019] [Indexed: 01/20/2023]
Abstract
The rising incidence of renal cell carcinoma (RCC) in recent decades necessitates careful consideration of additional treatment options, especially for patients who may be poor surgical candidates. An emerging body of evidence suggests that ablation may be performed effectively and safely even in patients with multiple comorbidities. Accordingly, clinical guidelines now include thermal ablation as an alternative for such patients with localized tumors that are 4.0 cm or smaller. Recent experience with these minimally invasive techniques has led to a greater understanding of the imaging findings that merit close attention when ablation is anticipated, or after it is performed. These imaging findings may guide the interventionalist's perception of the risks, technical challenges, and likelihood of treatment success associated with RCC ablation. The present review provides an overview of clinically relevant radiologic findings during the preprocedural, intraprocedural, and postprocedural period in the context of image-guided renal ablation. Keywords: Interventional-Body, Kidney, Percutaneous, Urinary © RSNA, 2019.
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Affiliation(s)
- Winston B Joe
- University of Alabama at Birmingham School of Medicine, Birmingham, Ala (W.B.J.); and Divisions of Abdominal Imaging (J.G.Z.) and Vascular and Interventional Radiology (A.J.G.), Department of Radiology, University of Alabama at Birmingham, 619 19th St S, Birmingham, AL 35249
| | - Jessica G Zarzour
- University of Alabama at Birmingham School of Medicine, Birmingham, Ala (W.B.J.); and Divisions of Abdominal Imaging (J.G.Z.) and Vascular and Interventional Radiology (A.J.G.), Department of Radiology, University of Alabama at Birmingham, 619 19th St S, Birmingham, AL 35249
| | - Andrew J Gunn
- University of Alabama at Birmingham School of Medicine, Birmingham, Ala (W.B.J.); and Divisions of Abdominal Imaging (J.G.Z.) and Vascular and Interventional Radiology (A.J.G.), Department of Radiology, University of Alabama at Birmingham, 619 19th St S, Birmingham, AL 35249
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Yamagami T, Yoshimatsu R, Kajiwara K, Yamanishi T, Minamiguchi H, Karashima T, Inoue K. Protection from injury of organs adjacent to a renal tumor during percutaneous cryoablation. Int J Urol 2019; 26:785-790. [PMID: 31094038 DOI: 10.1111/iju.14013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 04/07/2019] [Indexed: 01/20/2023]
Abstract
Renal cryoablation has become accepted as treatment for small renal tumors as an alternative to surgery. However, parallel with the increase in the use of this therapy, there also has been increases in the number of reports of complications related to renal cryoablation. One potential complication is injury to important non-renal structures adjacent to the ablated renal tumor, such as the colon, duodenum, ureter, psoas muscle and so on. To prevent injury of adjacent organs, separating organs from the tumor is desirable. Over the past 15 years, several techniques have been developed to protect against injury of organs adjacent to renal tumors that are targets of cryoablation. The most commonly used technique for this purpose has been hydrodissection. Others include dissection with gas, balloon dissection and probe traction. To avoid injury of a ureter running near the renal tumor, pyeloperfusion is known to be useful. The rate of cases necessitating avoidance of organ injury by using these techniques is relatively high. In some cases, more than two techniques are combined. In the present review, we provided an overview of techniques currently available to protect against organ injuries, and discussed the advantages and disadvantages of each technique.
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Affiliation(s)
- Takuji Yamagami
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Rika Yoshimatsu
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Kenji Kajiwara
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Tomoaki Yamanishi
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Hiroki Minamiguchi
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Takashi Karashima
- Department of Urology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Keiji Inoue
- Department of Urology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
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Sone M, Arai Y, Sugawara S, Tomita K, Fujiwara K, Ishii H, Morita S. Angio-CT-Assisted Balloon Dissection: Protection of the Adjacent Intestine during Cryoablation for Patients with Renal Cancer. J Vasc Interv Radiol 2017; 27:1414-1419. [PMID: 27566428 DOI: 10.1016/j.jvir.2016.02.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/21/2016] [Accepted: 02/21/2016] [Indexed: 10/21/2022] Open
Abstract
The present study describes the technical feasibility of a combined-modality angiography/computed tomography (angio-CT)-assisted balloon dissection technique for bowel protection during renal cryoablation in six procedures in five patients. A retrospective review was performed to evaluate balloon dissection using the angio-CT system. Mean bowel-to-tumor distances before and after balloon dissection were 0.9 mm (range, 0-3 mm) and 13.0 mm (range, 11-17 mm), respectively. No bowel injury was observed during the mean follow-up period of 19 months (range, 7-44 mo). Our preliminary experience suggests that balloon dissection using the angio-CT system for bowel protection during renal cryoablation may be feasible and effective.
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Affiliation(s)
- Miyuki Sone
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo 1040045, Japan.
| | - Yasuaki Arai
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo 1040045, Japan
| | - Shunsuke Sugawara
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo 1040045, Japan
| | - Koji Tomita
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo 1040045, Japan
| | - Keishi Fujiwara
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo 1040045, Japan
| | - Hiroaki Ishii
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo 1040045, Japan
| | - Shinichi Morita
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo 1040045, Japan
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Pneumodissection for skin protection in image-guided cryoablation of superficial musculoskeletal tumours. Eur Radiol 2016; 27:1202-1210. [PMID: 27287479 DOI: 10.1007/s00330-016-4456-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 04/22/2016] [Accepted: 05/30/2016] [Indexed: 01/20/2023]
Abstract
PURPOSE Pneumodissection is described as a simple method for preventing skin injury during cryoablation of superficial musculoskeletal tumours. METHODS Superficial tumour cryoablations performed from 2009 to 2015 were retrospectively reviewed. Pneumodissection was performed in 13 patients when the shortest tumour-skin distance was less than 25 mm. Indications were pain palliation (n = 9) and local tumour control (n = 4). Patients, target tumours, technical characteristics and complications up to 60 days post ablation were reviewed. The ice ball-skin distances with and without pneumodissection were compared by a paired t-test and further assessed for association with covariates using ANCOVA. RESULTS Technical success for ablation was 12 of 13. The mean shortest tumour-skin distance was 15.0 mm (3.2-24.5 mm). The mean thickness of pneumodissection was 9.6 mm (5.2-16.6 mm) resulting in mean elevation of skin of 3.4 mm (1.2-5.3 mm). Mean shortest ice ball-skin distance after pneumodissection was 10.5 mm (4.2-19.7 mm). No infection or systemic air embolism was noted. No intraprocedural frostbite was observed. CONCLUSION Pneumodissection is feasible, effective and safe in protecting the skin during image-guided cryoablation of superficial tumours. KEY POINTS • Frostbite during image-guided cryoablation of superficial tumours is commonly under-reported. • Frostbites are painful and may introduce infection into the superficial ablation zone. • Warm compress, saline and CO 2 have shortcomings in protecting the skin. • Pneumodissection is free, readily available, easy to use and safe and effective.
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