Ablation of tumors within the abdomen using percutaneous technique is a well accepted method of tumor treatment. There are some limitation of any percutaneous method in performance of ablation in critical regions. Newer techniques have been advocated in performance in RFA to treat tumors in difficult anatomical locations. Some of these regions that are difficult to treat include the following:

I. Diaphragm. Installation of water between the diaphragm and the lesion may protect the diaphragm from thermal injury. Other technique such as intentional pneumo or hydrothorax can be utilized for performance of RFA of hepatic lesions near the dome of the liver. The different technical maneuvers will be reviewed.

II. Bowel. When a hepatic or renal tumor abuts the stomach, small bowel or large intestine, mechanical means must be utilize to displace the bowel from the liver or renal neoplasm. Hydrodissection using D5W can be used to displaces the loop of the bowel from the tumor. This will thus allow coagulation of the tumor without injury to the adjacent bowel.

III. Gallbladder. When performing RF ablation of tissues adjacent to the gallbladder use of chemical ablation in addition to other ablative techniques may be helpful for treatment of hepatomas.

Some of these difficult areas for performing RF ablation will be reviewed and methods to avoid complications will be detailed.