Pros And Cons

Laparoscopic radiofrequency ablation has the advantage of approaching anteriorly located tumors safely and easier than percutaneous radiofrequency ablation. Also bowel and ureter that abut a tumor can be mobilized to prevent burn injuries.

During laparoscopic radiofrequency ablation, incisional biopsies, which have a higher diagnostic rate than needle core biopsies, can also be obtained using a laparo-scopic 5-mm cup biopsy instrument (25).

Percutaneous radiofrequency ablation has the advantage of an outpatient procedure that avoids a pneumoperitoneum, which may be poorly tolerated by select

TABLE3 ■ Summary of Percutaneous RFA

Obtain prone CT prior to ablation day to rule out any impediment for the ablation needle path

Ensure that bowel and ureter are not abutting the tumor

Use an 18-gauge needle to seek out tumor location on CT

Deploy tines and confirm tine coverage of tumor

Tru-cut biopsy can be obtained once RFA probe position is confirmed

Ablated according to manufacturer's recommendation

Track ablation while removing probe, stop ablation before probe starts coming through abdominal wall to prevent burn injuries Obtain final contrast-enhanced CT to confirm ablation

Abbreviations: RFA, radiofrequency ablation; CT, computed tomography.

patients. Also, computed tomography guidance provides greater resolution than ultrasound guidance, which is important for probe placement and confirmation of tine deployment. Smaller endophytic tumors are also better visualized with computed tomography.

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