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Video Abstract

SSO Top Rated Video Abstracts

V5: Laparoscopic-assisted, percutaneous cryoablation: a novel technique for the treatment of abdominal wall soft tissue tumors

Saturday, March 23, 2024
11:48am – 12:00pm ET
Location: C101
Disclosure(s):
Ansley B. Ricker, MD: No financial relationships to disclose
Introduction: Percutaneous cryoablation is a first-line therapeutic option for primary neoplasms and metastatic lesions of the musculoskeletal system. Treatment of abdominal wall tumors is challenging, as surgical resection can be highly morbid and necessitate complex reconstructive surgery, while the efficacy of cryoablation for abdominal wall tumors may be limited by inadequate posterior margins due to the proximity of intra-abdominal organs. With laparoscopy and insufflation, peritoneal structures can be safely mobilized away from the abdominal wall, allowing for adequate deep margin freeze and visualization of the ice ball. We present two patients with abdominal wall soft tissue tumors treated with a novel approach of laparoscopic-assisted, percutaneous ultrasound-guided cryoablation.


Methods: Patient 1 is a 65-year-old female with metastatic extraskeletal myxoid chondrosarcoma, stable on systemic therapy, who presented with a new soft tissue metastasis to the abdominal wall. Resection would have necessitated a highly morbid complex abdominal wall reconstruction with mesh. Patient 2 is a 35-year-old female with a large abdominal wall desmoid tumor, diagnosed after miscarriage. Resection was relatively contraindicated due to the morbidity of a complex abdominal wall reconstruction and concerns regarding potential future pregnancies after surgery.


Results: Both patients underwent procedures in the outpatient setting. Laparoscopic enterolysis was performed to mobilize the bowel away from the abdominal wall, to allow direct visualization of the peritoneal aspect of the tumor, and to confirm adequacy of the posterior margin freeze of the lesion. Laparoscopic transversus abdominus preperitoneal (TAPP) blocks with local anesthetic were performed for postoperative pain control. Musculoskeletal radiology performed an ultrasound-guided cryoablation consisting of two freeze and thaw cycles. Both patients recovered well without complication and were without radiographic evidence of persistent or recurrent disease at 4 and 11 months postoperative, respectively.


Conclusions: We report a novel approach of laparoscopic-assisted cryoablation for the treatment of abdominal wall soft tissue tumors. This allowed for successful minimally invasive local control of these large tumors that would have otherwise required highly morbid resections with complex abdominal wall reconstruction and mesh repair.

Learning Objectives:

  • Upon completion, participant will be able to describe a novel treatment approach via laparoscopic-assisted cryoablation for abdominal wall soft tissue tumors.
  • Upon completion, participant will be able to describe the circumstances in which one would choose to perform laparoscopic-assisted cryoablation for abdominal wall soft tissue tumors.
  • Upon completion, participant will be able to demonstrate understanding of a novel treatment approach via laparoscopic-assisted cryoablation for abdominal wall soft tissue tumors.