Abstract No. 399 - Organ protection during thermal ablation of tumors touching critical anatomy, such as the heart, bowel, or nerves

Abstract

Purpose To describe and characterize unconventional techniques for protecting organs during thermal ablation of tumors touching critical structures. Materials and Methods Retrospective analysis was performed of patients undergoing thermal ablation near heart, nerves, colon, rectum, duodenum, and gallbladder. Clinical records, lab values, imaging features, and procedural technical details were reviewed and collated in terms of organ protected, maneuver performed, volumes of hydro-dissection, degree of hyponatremia induced by 5 % dextrose intraperitoneal hydrodissection, and long term outcome in cases where nerves were injured. Results Non-target organ protection was successful for thermal ablation of tumors adjacent to heart, gallbladder, stomach, duodenum, colon, rectum, nerves, ureter. Hydrodissection was performed in a wide variety of locations and resulted in significant post-procedural hyponatremia in certain large volume infusions. Hydrodissection was not successful in certain post-operative patients, possibly limited by adhesions. Transhepatic hydrodissection is described, as well as pharmacologic maneuvers for gallbladder contraction, and stomoach or gut peristalsis. IV hydration with normal saline potentially corrected for hyponatremia. Nerve damage evident as parasthesias and numbness, was most often seen when hydrodissection was not used at all, and painful parasthesias were generally responsive to Gabapentin, when indicated. The liver was able to be rotated caudally (clockwise when facing patient) with large volume (up to 3 liters) hydrodissection, to avoid heart injury during successful ablation of tumors touching the heart. Conclusion Tumors touching the heart, bowel, or expected location of nerves may be successfuly ablated with targeted or large volume hydrodissection. IV normal saline can correct hyponatremia resulting from 5 % dextrose hydrodissection.