title: Thermal protection during percutaneous thermal ablation procedures: interest of carbon dioxide dissection and temperature monitoring.
abstract: Percutaneous image-guided thermal ablation of tumor is widely used, and thermal injury to collateral structures is a known complication of this technique. To avoid thermal damage to surrounding structures, several protection techniques have been reported. We report the use of a simple and effective protective technique combining carbon dioxide dissection and thermocouple: CO(2) displaces the nontarget structures, and its low thermal conductivity provides excellent insulation; insertion of a thermocouple in contact with vulnerable structures achieves continuous thermal monitoring. We performed percutaneous thermal ablation of 37 tumors in 35 patients (4 laser, 10 radiofrequency, and 23 cryoablations) with protection of adjacent vulnerable structures by using CO(2) dissection combined with continuous thermal monitoring with thermocouple. Tumor locations were various (19 intra-abdominal tumors including 4 livers and 9 kidneys, 18 musculoskeletal tumors including 11 spinal tumors). CO(2) volume ranged from 10 ml (epidural space) to 1500 ml (abdominal). Repeated insufflations were performed if necessary, depending on the information given by the thermocouple and imaging control. Dissection with optimal thermal protection was achieved in all cases except two patients where adherences (one postoperative, one arachnoiditis) blocked proper gaseous distribution. No complication referred to this technique was noted. This safe, cost-effective, and simple method increases the safety and the success rate of percutaneous thermal ablation procedures. It also offers the potential to increase the number of tumors that can be treated via a percutaneous approach.
authors.affiliation: Department of Radiology B, University Hospital of Strasbourg, 1, place de l'Hôpital, 67000, Strasbourg, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Buy
authors.forename: Chung-Hong
authors.initials: CH
authors.lastname: Tok
authors.forename: Daniel
authors.initials: D
authors.lastname: Szwarc
authors.forename: Guillaume
authors.initials: G
authors.lastname: Bierry
authors.forename: Afshin
authors.initials: A
authors.lastname: Gangi
mesh_terms: D000328:Adult; D001831:Body Temperature; D002245:Carbon Dioxide / Q000627:therapeutic use*; D017115:Catheter Ablation / Q000295:instrumentation*; D003452:Cryosurgery / Q000295:instrumentation*; D004553:Electric Conductivity; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009369:Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D015641:Radiography, Interventional; D014057:Tomography, X-Ray Computed
chemical_list: D002245:Carbon Dioxide