A Retrospective Overview of Balloon Dissection to Prevent Gastrointestinal Injury During Thermal Ablation of Renal and Liver Tumors

Abstract The aim of this study was to assess balloon dissection as an adjunctive technique during percutaneous thermal ablation of renal and hepatic tumors near critical structures. In this retrospective study, patients underwent CT-guided percutaneous ablation under general anesthesia for tumors located ≤1 cm from critical structures. A Yueh needle was used to access the space between the tumor and the critical structure, followed by Bentson wire insertion and vascular sheath placement to position a balloon, which was then inflated to create separation. The primary objectives were feasibility, safety, and technical success. Feasibility was defined as successful balloon placement; safety as procedure-related adverse events; and technical success as complete ablation with a >5 mm margin on immediate post-procedure imaging. Twelve patients underwent image-guided percutaneous ablation of kidney and liver lesions. Balloon placement between the target tumor and the adjacent bowel was successful in all cases. Six patients (50%) received cryoablation for renal cell carcinoma (RCC), and six (50%) underwent microwave ablation (MWA) for hepatocellular carcinoma (HCC, n = 2), colorectal liver metastases (CRLM, n = 2), and RCC liver metastases (n = 2). Mean tumor size was 3.7 cm (SD, 1.5) for renal tumors and 3.0 cm (SD, 1.3) for hepatic tumors. Technical success with sufficient tumor margins was achieved in all cases, and no thermal injury to adjacent structures was observed. One grade 1 and two grade 2 complications occurred, unrelated to balloon insertion. Balloon dissection is a technically feasible and safe technique to facilitate thermal ablation of renal and hepatic tumors located in proximity to critical structures.