Minimizing diaphragmatic injury during radio-frequency ablation: efficacy of subphrenic peritoneal saline injection in a porcine model.
OBJECTIVE
To investigate if a targeted subphrenic peritoneal infusion of normal saline to separate liver from diaphragm before radio-frequency (RF) ablation could minimize or eliminate diaphragmatic injury.


METHODS
With a 2-cm-diameter, eight-prong RF needle electrode, 37 hepatic dome RF lesions were created in 10 pigs. Seventeen lesions were created before (non-saline group) and 20 lesions after (post-saline group) intraperitoneal infusion of approximately 500 mL of normal saline. Ten non-saline lesions were created deep (centered 1-2 cm from the liver surface) and seven superficially (centered within 1 cm of the capsule). All 20 post-saline lesions were created superficially. Helical enhanced computed tomography was performed 24-48 hours after ablation. The pigs were killed immediately, and the diaphragm was visually inspected and sectioned. Diaphragmatic injury was graded as 0, no injury; 1, injury up to one-third thickness; 2, injury to two-thirds thickness; 3, full-thickness injury. Representative grade 3 injuries and all partial injuries underwent gross and histologic analysis.


RESULTS
All 10 deep non-saline RF lesions caused grade 0 injury. All seven superficial non-saline lesions caused grade 3 injury. Of the 20 superficial post-saline lesions, 13 (65%) caused grade 0 injury; four (20%), grade 1; and three (15%), grade 3. The post-saline group caused significantly less diaphragmatic injury (P <.05).


CONCLUSIONS
Intraperitoneal saline infusion may reduce the frequency and severity of diaphragmatic injury when adjacent liver is treated with RF ablation.
Raman
Steven S
SS
Department of Radiology, University of California Los Angeles School of Medicine, 10833 Le Conte Ave, Los Angeles, CA 90095-1721, USA. sraman@mednet.ucla.edu
Lu
David S K
DS
Vodopich
Darko J
DJ
Sayre
James
J
Lassman
Charles
C
D000818:Animals; D002056:Burns / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D003964:Diaphragm / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D007263:Infusions, Parenteral; D008099:Liver / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D012965:Sodium Chloride / Q000008:administration & dosage*; D013552:Swine
D012965:Sodium Chloride