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Feasibility, safety, and efficacy of artificial carbon dioxide pneumothorax for computed tomography fluoroscopy-guided percutaneous radiofrequency ablation of hepatocellular carcinoma. Jpn J Radiol 2021; 39:1119-1126. [PMID: 34089475 DOI: 10.1007/s11604-021-01148-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To retrospectively assess the feasibility, safety, and efficacy of artificial carbon dioxide (CO2) pneumothorax for computed tomography (CT) fluoroscopy-guided percutaneous radiofrequency (RF) ablation of hepatocellular carcinoma (HCC). MATERIALS AND METHODS This study included 26 sessions of 24 patients in whom the creation of artificial CO2 pneumothorax was attempted to avoid the transpulmonary route during CT fluoroscopy-guided percutaneous RF ablation of HCC between April 2011 and December 2017. In these 26 sessions, 29 HCCs (mean tumor diameter: 12 mm, range: 6-22 mm) were treated. RESULTS Adequate lung displacement after induction of artificial CO2 pneumothorax was achieved in 23 of the 26 sessions (88.5%). In the remaining three sessions, transpulmonary RF ablation, transthoracic extrapulmonary RF ablation after switching to an artificial pleural effusion procedure, or RF ablation with electrode insertion in the caudal-cranial oblique direction was performed. No major complications were found. Among the 29 treated tumors, one (3.4%) showed local progression, and the other 28 (96.6%) were completely ablated at the last follow-up (mean follow-up period: 39.3 months, range: 7-78 months). CONCLUSION Artificial CO2 pneumothorax for CT fluoroscopy-guided percutaneous RF ablation appeared to be a feasible, safe, and useful therapeutic option for HCC.
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Zuo T, Lin W, Liu F, Xu J. Artificial pneumothorax improves radiofrequency ablation of pulmonary metastases of hepatocellular carcinoma close to mediastinum. BMC Cancer 2021; 21:505. [PMID: 33957875 PMCID: PMC8101170 DOI: 10.1186/s12885-021-08223-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 04/20/2021] [Indexed: 02/08/2023] Open
Abstract
Background To investigate the feasibility, safety and efficacy of percutaneous radiofrequency ablation (RFA) of pulmonary metastases from hepatocellular carcinoma (HCC) contiguous with the mediastinum using the artificial pneumothorax technique. Method A total of 40 lesions in 32 patients with pulmonary metastases from HCC contiguous with the mediastinum accepted RFA treatment from August 2014 to May 2018 via the artificial pneumothorax technique. After ablation, clinical outcomes were followed up by contrast enhanced CT. Technical success, local tumor progression (LTP), intrapulmonary distant recurrence (IDR), and adverse events were evaluated. Overall survival (OS) and local tumor progression free survival (LTPFS) were recorded for each patient. Results The tumor size was 1.4 ± 0.6 cm in diameter. RFA procedures were all successfully performed without intra-ablative complications. Technical success was noted in 100% of the patients. Five cases of LTP and 8 cases of IDR occurred following the secondary RFA for treatment. Slight pain was reported in all patients. No major complications were observed. The 1, 2, and 3-year LTPFS rates were 90.6, 81.2, and 71.8%, and the 1, 2, and 3-year OS rates were 100, 100 and 87.5%, respectively. Conclusion Artificial pneumothorax adjuvant RFA is a feasible, safe, and efficient method for treatment of pulmonary metastases from HCC contiguous with the mediastinum.
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Affiliation(s)
- Taiyang Zuo
- Department of Interventional Oncology, Jinan Central Hospital Affiliated to Shandong University, Jinan, 250013, Shandong, China.,Department of Interventional Radiology, Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, 100853, Shandong, China
| | - Wenli Lin
- Department of Interventional Oncology, Jinan Central Hospital Affiliated to Shandong University, Jinan, 250013, Shandong, China
| | - Fengyong Liu
- Department of Interventional Oncology, Jinan Central Hospital Affiliated to Shandong University, Jinan, 250013, Shandong, China.,Department of Interventional Radiology, Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, 100853, Shandong, China
| | - Jinshun Xu
- Department of Interventional Oncology, Jinan Central Hospital Affiliated to Shandong University, Jinan, 250013, Shandong, China. .,Department of Interventional Radiology, Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, 100853, Shandong, China. .,Department of Medical Ultrasound, Laboratory of Ultrasound Imaging Drug, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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Diagnostic outcome and safety of CT-guided core needle biopsy for mediastinal masses: a systematic review and meta-analysis. Eur Radiol 2019; 30:588-599. [DOI: 10.1007/s00330-019-06377-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 06/13/2019] [Accepted: 07/18/2019] [Indexed: 12/17/2022]
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Hou X, Zhuang X, Zhang H, Wang K, Zhang Y. Artificial pneumothorax: a safe and simple method to relieve pain during microwave ablation of subpleural lung malignancy. MINIM INVASIV THER 2017; 26:220-226. [PMID: 28281366 DOI: 10.1080/13645706.2017.1287089] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Microwave ablation has been extensively used for eliminating pulmonary tumors; however, it is usually associated with severe pain under local anesthesia. Decreasing the power and shortening the ablation time can help to relieve the pain; however, this leads to incomplete ablation and an increasing recurrence rate. This research aims to employ an artificial pneumothorax to increase both the curative effect and pain relief during the ablation procedure. MATERIAL AND METHODS From July 2013 to January 2015, nine patients presenting with 10 subpleural lung tumors (age: 44-78 years) with a high possibility of severe pain underwent the artificial pneumothorax during microwave ablation. The pain assessment scores and complications induced by the artificial pneumothorax were recorded and analyzed by a CT scan follow-up. RESULTS The tumors of the nine patients were eliminated successfully using microwave ablation with artificial pneumothorax under local anesthesia. The pain caused by the ablation was relieved to a great extent with an average rate of 94.66% (range: 63.3%-100%) and all tumors were ablated completely. No severe complications occurred after the operation. CONCLUSIONS The artificial pneumothorax is a reliable therapy to improve the curative effect of microwave ablation under local anesthesia by relieving the pain of the patients.
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Affiliation(s)
- Xiaowei Hou
- a Department of Oncology , PLA 401 Hospital , Qingdao , China
| | - Xingjun Zhuang
- a Department of Oncology , PLA 401 Hospital , Qingdao , China
| | - Haiwen Zhang
- a Department of Oncology , PLA 401 Hospital , Qingdao , China
| | - Kai Wang
- a Department of Oncology , PLA 401 Hospital , Qingdao , China
| | - Yuanxin Zhang
- b Department of Anesthesiology , PLA 401 Hospital , Qingdao , China
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Kavanagh J, Siemienowicz ML, Lyen S, Kandel S, Rogalla P. Protective Capnothorax During Transthoracic Needle Biopsy. Cardiovasc Intervent Radiol 2016; 40:603-608. [PMID: 28028576 DOI: 10.1007/s00270-016-1549-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 12/14/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE Transthoracic needle biopsy (TTNB) is an established procedure in the management of pulmonary nodules. The most common complications are directly related to crossing the lung or visceral pleura during the biopsy. In this study, we describe the use of carbon dioxide instead of room air to create a protective "capnothorax" during TTNB. MATERIALS AND METHODS Five patients underwent creation of a capnothorax during TTNB. Parameters recorded were location and size of target, distance from pleura, length of procedure, volume of carbon dioxide, periprocedural complications and biopsy result. RESULTS Induction of capnothorax was successful in all cases. In two patients, a continuous infusion of carbon dioxide was required to maintain an adequate volume of intrapleural gas. In two patients, the carbon dioxide resolved spontaneously and in the remaining patients it was aspirated at the end of the procedure. All biopsies were diagnostic with no periprocedural or postprocedural complications. CONCLUSION This study suggests that protective iatrogenic capnothorax is a safe and effective technique during TTNB. The intrinsic properties and availability of carbon dioxide make it an attractive alternative to room air.
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Affiliation(s)
- John Kavanagh
- Division of Cardiothoracic Imaging, Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
| | - Miranda L Siemienowicz
- Division of Cardiothoracic Imaging, Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Stephen Lyen
- Division of Cardiothoracic Imaging, Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Sonja Kandel
- Division of Cardiothoracic Imaging, Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Patrik Rogalla
- Division of Cardiothoracic Imaging, Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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Lin ZY, Chen J. Treatment of recurrent mediastinal lymph node metastasis using CT-guided nontranspulmonary puncture interstitial implantation of (125)I seeds: Evaluation of initial effect and operative techniques. Brachytherapy 2016; 15:361-369. [PMID: 27004685 DOI: 10.1016/j.brachy.2016.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 02/06/2016] [Accepted: 02/19/2016] [Indexed: 01/11/2023]
Abstract
PURPOSE To evaluate the initial effects and operative techniques for treating recurrent mediastinal lymph node metastasis using CT-guided nontranspulmonary puncture interstitial implantation of (125)I seeds. METHODS AND MATERIALS Thirteen patients (eight men and five women) with a total of 14 recurrent mediastinal lymph node metastatic lesions underwent CT-guided nontranspulmonary puncture interstitial implantation of (125)I seeds. RESULTS We used the transpleural cavity approach for six cases (air injection of 200-600 mL), the transsternal approach for three cases, the supersternal approach for one case, and the parasternal/paraspinal approach for the remaining cases (including two cases using the salinoma window technique). All patients had good operational tolerance. Mean followup was 16.3 months, with 12 complete response lesions and 2 partial response lesions. CONCLUSIONS Treating recurrent mediastinal lymph node metastasis using CT-guided nontranspulmonary puncture interstitial implantation of (125)I seeds is safe and effective, with minimal trauma, evident local therapeutic effects, and does not damage lung tissue. However, comprehensive application of multiple puncture assistive technologies, and skill, is required due to the important, anatomically complex structures in the mediastinum.
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Affiliation(s)
- Zheng-Yu Lin
- Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
| | - Jin Chen
- Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Lin ZY, Li YG. Artificial pneumothorax with position adjustment for computed tomography-guided percutaneous core biopsy of mediastinum lesions. Ann Thorac Surg 2009; 87:920-4. [PMID: 19231419 DOI: 10.1016/j.athoracsur.2008.10.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 10/09/2008] [Accepted: 10/14/2008] [Indexed: 11/26/2022]
Abstract
PURPOSE This study was designed to assess the use of artificial pneumothorax with position adjustment to gain a pleural space approach in computed tomographic-guided core biopsy of mediastinal masses. DESCRIPTION Eleven patients with mediastinal lesions who were undergoing percutaneous core biopsies received an artificial pneumothorax with a 22-gauge lumbar puncture needle. Each patient's position was adjusted to place the lesion as high as possible in the thoracic cavity. Air was injected until the lung was displaced from the path of the biopsy needle. After completion of the biopsy, a comparable volume of air was aspirated. EVALUATION In all patients, satisfactory displacement of the lung from the biopsy site was achieved with the artificial pneuomothorax procedure enabling the target lesion to be reached. No postoperative air leaks requiring tube drainage were encountered. CONCLUSIONS Artificial pneumothorax with position adjustment is a safe and effective method that provides access for computed tomographic-guided biopsy of mediastinal lesions without the risks of traversing aerated lung tissue and with a relatively low volume of injected air.
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Affiliation(s)
- Zheng-Yu Lin
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
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Mortman KD. Invited commentary. Ann Thorac Surg 2009; 87:924. [PMID: 19231420 DOI: 10.1016/j.athoracsur.2008.10.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Revised: 10/28/2008] [Accepted: 10/31/2008] [Indexed: 10/21/2022]
Affiliation(s)
- Keith D Mortman
- Section of Thoracic Surgery, Cleveland Clinic Florida, Weston, FL33331, USA.
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Radiofrequency ablation of subpleural lung malignancy: reduced pain using an artificially created pneumothorax. Cardiovasc Intervent Radiol 2009; 32:833-6. [PMID: 19194744 PMCID: PMC2705717 DOI: 10.1007/s00270-009-9513-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Revised: 12/22/2008] [Accepted: 01/08/2009] [Indexed: 11/21/2022]
Abstract
One of the main issues with radiofrequency (RF) ablation of the subpleural lung malignancy is pain management during and after RF ablation. In this article, we present a case that utilized a technique to decrease the pain associated with RF ablation of a malignancy located within the subpleural lung. Under CT guidance, we created an artificial pneumothorax prior to the RF ablation, which resulted in minimizing the pain usually experienced during and after the procedure. It also decreased the amount of pain medications usually used in patients undergoing RF ablation of a subpleural lung lesion.
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Solomon SB, Thornton RH, Dupuy DE, Downey RJ. Protection of the Mediastinum and Chest Wall with an Artificial Pneumothorax during Lung Ablations. J Vasc Interv Radiol 2008; 19:610-5. [DOI: 10.1016/j.jvir.2008.01.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2007] [Revised: 12/30/2007] [Accepted: 01/03/2008] [Indexed: 10/22/2022] Open
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