Fluoroscopy guided ablation of hepatic dome and subcapsular liver tumors with emphasis on fluoro-hydro dissection: A case series

Thermal ablation is a safe, well-established, and effective treatment option for primary and metastatic liver tumors. Traditionally, the placement of the thermal ablation needle is performed under ultrasonography or computerised tomography guidance as the liver lesions are usually well appreciated in these modalities. However, in certain subset of patients, percutaneous access to hepatic dome lesions may be restricted due to anatomical factors, accessibility, poor visibility and localization. This case series highlights the successful ablation of malignant hepatic dome and subcapsular liver tumors, employing a synergistic approach combining ultrasonography and fluoroscopy guidance. To enhance precision and therapeutic outcomes, adjuvant techniques such as fluoro-hydrodissection, coil marking, and transarterial chemoembolization (TACE) were strategically integrated. The use of these innovative methods helped to minimize the risk of non-target organ injury and enhance the precision of the ablation process for improving patient outcomes.