CIO 2021-29 Microwave Renal Ablation – Effective Utilization of Hydrodissection

Purpose: To summarize the current literature on hydrodissection technique in the setting of percutaneous renal microwave ablation.

Material and Methods: Percutaneous renal thermal ablation has become a well-established safe and effective treatment option for small renal cell carcinoma ( <4cm), with the most feared complications stemming from unintended thermal damage to surrounding vital organs such as small bowel, colon, and pancreas [1]. There have been multiple techniques described to minimalize the risk of unintended thermal injury. However, this education exhibit will review the current literature on hydrodissection, which is a common technique employed to gain adequate separation between targeted renal lesions and adjacent structures.

Results: Hydrodissection is one of the most common techniques employed to gain adequate separation between targeted renal lesions and adjacent organs/structures. Hydrodisection involves placing a needle/small catheter directly between the renal lesion and adjacent organ, followed by the instillation of a water solution mixed with a dilute contrast agent to improve CT visualization. In the literature, hydrodissection utilization is mostly described in the setting of providing small bowel, colon, and pancreas protection; however, it is important to also understand the other less reported protective considerations including spleen, nerves, and musculature[2][3].

Conclusions: Hydrodissection is considered a reliable technique to reduce the risk of unintended thermal injury to vulnerable organs. Therefore, it is important for the Intervention Radiologist to understand the most recent indications and techniques.