Abstract
AimTo evaluate the effect of high-frequency jet ventilation (HFJV) in place of standard intermittent positive-pressure ventilation (IPPV) on procedure duration, patient radiation dose, complication rates, and outcomes during CT-guided cryoablation of small renal tumours.Materials and MethodsOne hundred consecutive CT-guided cryoablation procedures to treat small renal tumours under general anaesthesia were evaluated—50 with standard IPPV and 50 after the introduction of HFJV as standard practice. Anaesthesia and procedural times, ionising radiation dose, complications, and 1-month post-treatment outcomes were collected.ResultsHFJV was feasible and safe in all cases. Mean procedure time and total anaesthetic time were shorter with HFJV (p = <0.0001). The number of required CT acquisitions (p = 0.0002) and total procedure patient radiation dose (p = 0.0027) were also lower in the HFJV group compared with the IPPV group. There were a total of four complications of Clavien–Dindo classification 3 or above—three in the IPPV group and one in the HFJV group. At 1-month follow-up, two cases (both in the IPPV group) demonstrated subtotal treatment. Both cases were subsequently successfully retreated with cryoablation.ConclusionBy reducing target tumour motion during CT-guided renal cryoablation, HFJV can reduce procedure times and exposure to ionising radiation. HFJV provides an important adjunct to complex image-guided interventions, with potential to improve safety and treatment outcomes.
Highlights
Modern management of small renal masses has moved towards nephron-sparing techniques—that include partial nephrectomy (PN) and image-guided ablation (IGA)
Secondary outcomes included: probe placement time, patient radiation dose (represented by dose length product (DLP) generated automatically at the scanner console), number of CT acquisitions, and complication rates following CT-guided cryoablation of small renal tumours
None of the patients intended for high-frequency jet ventilation (HFJV) required a switch in ventilation technique to intermittent positivepressure ventilation (IPPV)
Summary
Modern management of small renal masses has moved towards nephron-sparing techniques—that include partial nephrectomy (PN) and image-guided ablation (IGA). IGA allows minimally invasive tumour destruction with significantly reduced patient impact [1], preserved renal function [2], and oncological outcomes that are equivalent to surgical resection [3]. Minimising rates of local recurrence following IGA requires diligent technique to ensure ablative energy is delivered precisely to the tumour with an appropriate margin. Cryoablation (CYA) has become the technique of choice, with multiple probes carefully positioned simultaneously within the tumour to produce a conformal treatment zone or ‘iceball’ that can be visually confirmed on intra-operative CT or MRI. Despite immobilisation with general anaesthesia, traditional intermittent positive-pressure ventilation (IPPV) causes significant abdominal organ motion making tumour targeting more difficult [4]. Probes must be inserted between respiratory cycles or during short periods of
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