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Title: Gallbladder Cryoablation: Proof of Concept in a Swine Model for a Percutaneous Alternative to Cholecystectomy

Abstract

PurposeTo investigate the feasibility of percutaneous gallbladder cryoablation (GBC) under CT guidance in a swine model with histopathologic correlation.Materials and MethodsInstitutional Animal Care and Use Committee approval was obtained for this study protocol. Five pigs underwent GBC. Under CT guidance, 3–4 cryoprobes were positioned percutaneously at the gallbladder margins. Thermocouple probes were placed percutaneously at the gallbladder fundus, neck, free wall, and gallbladder fossa. Two freeze–thaw cycles ranging from 10 to 26 min were performed. The subjects were sacrificed 5 h after cryoablation. The gallbladder and bile ducts were resected, stained, and examined microscopically.ResultsGBC was completed in all subjects. A 10-mm ablation margin was achieved beyond all gallbladder walls. Thermocouple probes reached at least −20 °C. Intra-procedural body temperature decreased to a minimum of 35 °C but recovered after the procedure. Intra- and post-procedural vital signs otherwise remained within physiologic parameters. Non-target ablation occurred in the stomach and colon of the first two subjects. Histology demonstrated complete denudation of the gallbladder epithelium, hemorrhage, and edema within the muscularis layer, and preservation of the microscopic architecture of the common bile duct in all cases.ConclusionPercutaneous gallbladder cryoablation is feasible, with adequate ablation margins obtained and histologic changes demonstrating transmural necrosis. Adjacent structures included in the ablationmore » may require conservative ablation zones, hydrodissection, or continuous saline lavage.« less

Authors:
; ; ; ; ; ;  [1]
  1. University of California San Francisco, Department of Radiology and Biomedical Imaging (United States)
Publication Date:
OSTI Identifier:
22642476
Resource Type:
Journal Article
Journal Name:
Cardiovascular and Interventional Radiology
Additional Journal Information:
Journal Volume: 39; Journal Issue: 7; Other Information: Copyright (c) 2016 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); http://www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0174-1551
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ABLATION; BILE; BILIARY TRACT; BODY TEMPERATURE; COMPUTERIZED TOMOGRAPHY; EDEMA; EPITHELIUM; HEMORRHAGE; HISTOLOGY; LARGE INTESTINE; NECK; NECROSIS; STOMACH; SWINE; THERMOCOUPLES

Citation Formats

McGregor, Hugh C. J., E-mail: hugh.mcgregor@ucsf.edu, Saeed, Maythem, E-mail: maythem.saeed@ucsf.edu, Surman, Andrew, E-mail: andrew.surman@ucsf.edu, Ehman, Eric C., E-mail: eric.ehman@ucsf.edu, Hetts, Steven W., E-mail: steven.hetts@ucsf.edu, Wilson, Mark W., E-mail: mark.wilson@ucsf.edu, and Conrad, Miles B., E-mail: miles.conrad@ucsf.edu. Gallbladder Cryoablation: Proof of Concept in a Swine Model for a Percutaneous Alternative to Cholecystectomy. United States: N. p., 2016. Web. doi:10.1007/S00270-016-1343-0.
McGregor, Hugh C. J., E-mail: hugh.mcgregor@ucsf.edu, Saeed, Maythem, E-mail: maythem.saeed@ucsf.edu, Surman, Andrew, E-mail: andrew.surman@ucsf.edu, Ehman, Eric C., E-mail: eric.ehman@ucsf.edu, Hetts, Steven W., E-mail: steven.hetts@ucsf.edu, Wilson, Mark W., E-mail: mark.wilson@ucsf.edu, & Conrad, Miles B., E-mail: miles.conrad@ucsf.edu. Gallbladder Cryoablation: Proof of Concept in a Swine Model for a Percutaneous Alternative to Cholecystectomy. United States. doi:10.1007/S00270-016-1343-0.
McGregor, Hugh C. J., E-mail: hugh.mcgregor@ucsf.edu, Saeed, Maythem, E-mail: maythem.saeed@ucsf.edu, Surman, Andrew, E-mail: andrew.surman@ucsf.edu, Ehman, Eric C., E-mail: eric.ehman@ucsf.edu, Hetts, Steven W., E-mail: steven.hetts@ucsf.edu, Wilson, Mark W., E-mail: mark.wilson@ucsf.edu, and Conrad, Miles B., E-mail: miles.conrad@ucsf.edu. Fri . "Gallbladder Cryoablation: Proof of Concept in a Swine Model for a Percutaneous Alternative to Cholecystectomy". United States. doi:10.1007/S00270-016-1343-0.
@article{osti_22642476,
title = {Gallbladder Cryoablation: Proof of Concept in a Swine Model for a Percutaneous Alternative to Cholecystectomy},
author = {McGregor, Hugh C. J., E-mail: hugh.mcgregor@ucsf.edu and Saeed, Maythem, E-mail: maythem.saeed@ucsf.edu and Surman, Andrew, E-mail: andrew.surman@ucsf.edu and Ehman, Eric C., E-mail: eric.ehman@ucsf.edu and Hetts, Steven W., E-mail: steven.hetts@ucsf.edu and Wilson, Mark W., E-mail: mark.wilson@ucsf.edu and Conrad, Miles B., E-mail: miles.conrad@ucsf.edu},
abstractNote = {PurposeTo investigate the feasibility of percutaneous gallbladder cryoablation (GBC) under CT guidance in a swine model with histopathologic correlation.Materials and MethodsInstitutional Animal Care and Use Committee approval was obtained for this study protocol. Five pigs underwent GBC. Under CT guidance, 3–4 cryoprobes were positioned percutaneously at the gallbladder margins. Thermocouple probes were placed percutaneously at the gallbladder fundus, neck, free wall, and gallbladder fossa. Two freeze–thaw cycles ranging from 10 to 26 min were performed. The subjects were sacrificed 5 h after cryoablation. The gallbladder and bile ducts were resected, stained, and examined microscopically.ResultsGBC was completed in all subjects. A 10-mm ablation margin was achieved beyond all gallbladder walls. Thermocouple probes reached at least −20 °C. Intra-procedural body temperature decreased to a minimum of 35 °C but recovered after the procedure. Intra- and post-procedural vital signs otherwise remained within physiologic parameters. Non-target ablation occurred in the stomach and colon of the first two subjects. Histology demonstrated complete denudation of the gallbladder epithelium, hemorrhage, and edema within the muscularis layer, and preservation of the microscopic architecture of the common bile duct in all cases.ConclusionPercutaneous gallbladder cryoablation is feasible, with adequate ablation margins obtained and histologic changes demonstrating transmural necrosis. Adjacent structures included in the ablation may require conservative ablation zones, hydrodissection, or continuous saline lavage.},
doi = {10.1007/S00270-016-1343-0},
journal = {Cardiovascular and Interventional Radiology},
issn = {0174-1551},
number = 7,
volume = 39,
place = {United States},
year = {2016},
month = {7}
}