Minimizing abdominal wall damage during high-intensity focused ultrasound ablation by inducing artificial ascites

High-intensity focused ultrasound (HIFU) is becoming an important tool for tumor treatment [especially hepatocellular carcinoma (HCC)] in Asian countries. A HIFU system provides unique advantages of low invasiveness and absence of nonradiation. However, if the target HCC is close to the proximal surface of the liver, HIFU may overheat diaphragm, abdominal wall or skin. To avoid this complication, a method using artificial ascites in the abdominal cavity to separate the liver from the peritoneum, and to serve as a heat sink to cool overlying structures and thereby avoid inducing permanent damage was proposed. Target tissue that was 10 mm below the liver surface was ablated in 12 New Zealand white rabbits: 6 in the experimental group and 6 in the control group. Artificial ascites was established in the experimental group by injecting normal saline into the abdominal cavity until the pressure reached 150 mm H2O. Artificial ascites not only reduced the probability and extent of thermal damage to intervening structures, but also had no adverse affect on the efficacy of HIFU ablation.