37 - Safety and Feasibility of Balloon Dissection to Facilitate Cryoablation of Renal Masses at a Single Institution

Purpose: Thermal ablation is an effective, minimally invasive treatment for solid organ tumors, but achieving adequate ablation margins without injuring adjacent critical structures remains challenging {1–3}. In renal tumor cryoablation, protective techniques such as hydrodissection or pneumodissection are often required to displace vulnerable tissues away from the ablation zone and reduce the risk of thermal injury or perforation. Balloon catheter dissection represents an alternative approach, using carbon dioxide–filled angioplasty balloons to mechanically separate structures. This technique offers a practical, reproducible method to extend the safety and feasibility of cryoablation in anatomically challenging settings.

Materials and Methods: We report our single-institution experience between 2020 and 2025 utilizing balloon dissection to facilitate cryoablation of renal masses. 5 patients (male; mean age 65 years) presented to our institution for cryoablation of renal lesions between November 2020 and August 2025. 3 patients presented for CT-guided biopsy before cryoablation, 1 patient presented with confirmed renal cell carcinoma, and 1 presented with confirmed metastatic esophageal carcinoma.

Results: All cryoablation procedures followed maximal sterile barrier technique with appropriate sedation and utilized Boston Scientific VISUAL ICE™ cryoablation needles. To dissect adjacent colon away from the kidney, BD balloon catheters of various sizes were employed, including: 16mm x 60mm Atlas™ (4 patients), 16 mm x 40 mm Atlas™ (1 patient). Scanning throughout the procedures demonstrated adequate coverage of lesions and margins away from critical structures, with successful cryoabation of renal lesions and no bowel injury. Only 1 patient demonstrated a small, stable right perirenal hematoma following completion of cryoablation.

Conclusion: For patients who require cryoablation for renal lesions, balloon dissection is a safe, feasible option to displace the kidney from neighboring structures and minimize the risk of injury. Further investigation is required in additional patients, along with a comparison of the efficacy of displacement methods including hydrodissection, pneumodissection, and balloon dissection.