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Minimizing Diaphragmatic Injury During Radiofrequency Ablation: Efficacy of Intraabdominal Carbon Dioxide Insufflation

Steven S. Raman1, Donya Aziz, Xinlan Chang, James Sayre, Charles Lassman and David Lu

1 All authors: Department of Radiology, David Geffen School of Medicine at UCLA, BL-428 CHS/Box 951721, Los Angeles, CA 90095-1721.



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  		Fig. 1. —Photograph of percutaneous CO2 insufflation apparatus. Seventeen-gauge needle (arrow) was inserted infraumbilically via 5-mm skin incision, and CO2 flow rate was adjusted to reach maximum in-traabdominal pressure of 10 mm Hg at maximum flow rate of 6–8 mL/hr.

 


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  		Fig. 2. —Photograph of gross postmortem liver surface and diaphragm shows several superficial hepatic thermal lesions. Diaphragm is notable for several LeVeen needle electrode (Boston Scientific) entry sites (arrowheads) and single grossly injured region (arrows) of diaphragm.

 


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  		Fig. 3. —Photograph shows representative gross liver section revealing quantified superficial thermal lesion.

 


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  		Fig. 4. —Photograph shows representative cross section of grade III (full thickness) diaphragmatic injury (arrow). PL = pleural surface, PE = peritoneal surface.

 

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