CT-guided Percutaneous RF Lung Ablation

Nancy Boulanger 9/18/2007

Description: Guidelines for CT-guided Percutaneous RF Lung Ablation

CT-guided Percutaneous RF Lung Ablation

Tomorrow we'll be doing our first RFA lung case with Dr. Paul Harrod-Kim, the new interventional radiologist. They'll take place in the CT scanner near RADCU. They are for patients who are medically inoperable but have localized disease. Dr. Harrod-Kim expects to do 1-2 cases a month. At his prior institution they did 80% of these cases with conscious sedation. The other 20% needed general anesthesia because of issues like lesions near ribs which are more painful to ablate. Here we'll be doing the first several cases with GA, then they will probably do most with conscious sedation and we'll only do general anesthesia for the 20% or so that really need it. He does not need the patients paralyzed. LMA's are fine when appropriate. The patients' positions may vary from supine to prone depending on where the lesion is. No special lines or monitoring are required. The cases will take from one and a half to two hours. The patients will be admitted to RADCU the day of the procedure, after being seen at PAU. Dr. Harrod-Kim will order pre-op abx. Patients will have a noncontrast CT, get positioned, the RF probe will be placed under CT guidance and the lesion burned, then they'll have another CT post-ablation. Patients will recover in PACU, at least for the first several cases. They'll spend one night in SS then be discharged home. Complications: 1) Pneumothorax: 30% get a ptx (about the same % as with lung bxs done in readiology). Most are small. 10% require a small chest tube, which Dr. Harrod-Kim will place at the time of the procedure. 2) Bleeding: this is rare, as the lesions are cauterized by the ablating probe. In cases with significant bleeding patients would likely go to angio rather than the OR. 3) Pleural effusions: rare, tend to develop later over the week. There is one case tomorrow and one on Friday 9/21. I'll be in touch with the staff doing these cases with more details about the individual patients. Please let me know if you have any questions. Thanks.

First case done today. Overall went well. Once again, I did not notify the workroom so they were unaware we were doing this. We need to make sure they are made aware so we will have necessary equipment from one of the other radiology sites. Had to get the machine and bluebell from angio.

Did this with LMA, GA. Partial prone induction and LMA insertion (sorry PL). This was a rib lesion so expected to be painful but evidently the radiologist thoroughly injected the site because the anesthetic requirements were very low thru case. Took about 2 hours, half of this was positioning, getting used to new equipment etc.

Another case on Friday (this one is a more central lung lesion) then none for a while until radiology techs and nurses get better prepared. Sounds like there are plenty of candidates for this though, based on the discussions with the new interventionist.