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RESIDENTíS CORNER
Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 84-85

Utilization of hydro-dissection: A novel technique during ongoing COVID pandemic


1 Department of Radiology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
2 Department of Histopathology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India

Date of Submission28-Oct-2020
Date of Acceptance05-Nov-2020
Date of Web Publication31-Dec-2020

Correspondence Address:
Dr. Ankush Jajodia
Department of Radiology- Rajiv Gandhi Cancer Institute and Research Centre, Rohini sector 5, Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jco.jco_36_20

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How to cite this article:
Bansal A, Chaturvedi AK, Kapur R, Pasricha S, Jajodia A. Utilization of hydro-dissection: A novel technique during ongoing COVID pandemic. J Curr Oncol 2020;3:84-5

How to cite this URL:
Bansal A, Chaturvedi AK, Kapur R, Pasricha S, Jajodia A. Utilization of hydro-dissection: A novel technique during ongoing COVID pandemic. J Curr Oncol [serial online] 2020 [cited 2021 Jan 18];3:84-5. Available from: https://www.journalofcurrentoncology.org/text.asp?2020/3/2/84/305853



The rapid spread of nefarious pulmonary illness, originating in Wuhan in late November 2019, led to the declaration of a global pandemic by the World Health Organization identified as novel corona virus disease, COVID-19.[1] Health-care personnel battle this serious form of illness at the forefront, and interventional radiology subspecialty carries additional risk of exposure due to close contact with patients.[2] Various international societies laid down imaging guidelines on dealing with this pandemic and figured out a way to deal with the invasive procedures during the crisis. Bronchoscopy, as a part of the diagnostic procedure for a highly suspicious case of cancer, was classified in the semiurgent category. Bronchoscopy was classified as an aerosol-generating procedure, which, in addition to the N95 mask, gloves, face shield, and blue isolation gown, also had the additional requirement of a negative pressure room with adequate manpower.[3],[4]

Because “time and tide waits for no man,” similarly cancerous cells do not stop dividing or spreading, and oncologists rely on interventional radiology to answer their queries even during this great pandemic. Percutaneous biopsies offer the advantage of being a daycare-based procedure, thus abating prolonged stay at hospital, and are cost-effective than surgical approaches. The tissue yield obtained is comparable to surgical approaches, and better than restricted cytological analysis feasible using bronchoscopic examinations.

A 32-year-old married female, with a past history of surgery for an adnexal lesion, done three months ago at another institute, now presented with difficulty during swallowing. Her serum CA125 levels were within normal limits, and the histopathological conclusion of past surgery was dysgerminoma of an ovarian origin. A routine computed tomography examination of the chest and abdomen revealed a residual complex solid cystic lesion in the pelvis, with no obvious nodular enhancing lesion in the solid abdominal organs or in the peritoneum and an ill-defined mass in the subcranial region. We carried out histopathological tissue sampling of the subcranial mass, by using the hydro-dissection technique [Figure 1]. The patient spent less than 10 minutes inside the gantry of the CT machine, followed by institutional protocol of three hours of observation in routine daycare for the development of any ominous sign, after which the patient was discharged.
Figure 1: (A-D) Technique of hydro-dissection performed in prone position. Unenhanced CT image (A) shows retroperitoneal lymph node (yellow arrow) medial to aorta (red arrow). Unenhanced CT image (B) shows sleeve of saline injected to displace endo-thoracic fascia and aorta laterally. Enhanced CT image acquired by injection of 40ml of iodinated contrast (C) shows the needle carefully transfixing the lymph node; image (D) CT axial section in lung window shows no pneumothorax. The biopsy was safely performed, confirming the diagnosis of Granulation tissue.

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The technique of hydro-dissection[5] and organ displacement for gaining safe access to target organs is not new, but utilizing this efficient method to displace the mediastinal pleura and create a safe passage to reach the subcranial zone during COVID has not been addressed, to the best of the authors’ knowledge. This novel method widens our access to the central structures in the mediastinum, which otherwise would require prolonged stay and heightened invasiveness of either bronchoscopy route. Either of this is not desirable during COVID, with the added advantage of avoiding percutaneous puncture of the pleura and traversing the lung parenchyma to access the central structures. These minimally invasive procedures can be considered as a first-line resort during COVID.[6]

Acknowledgments

The authors thank the patients and their families for their munificence in contributing to this study. They would also like to thank all members of the IRB committee who gave their approval for this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Jajodia A, Ebner L, Heidinger B, Chaturvedi A, Prosch H Imaging in corona virus disease 2019 (COVID-19)—A scoping review. Eur J Radiol open2020;7:100237.  Back to cited text no. 1
    
2.
Chandy PE, Nasir MU, Srinivasan S, Klass D, Nicolaou S, B Babu S Interventional radiology and COVID-19: Evidence-based measures to limit transmission. Diagn Interv Radiol 2020;26:236-40.  Back to cited text no. 2
    
3.
Chiu PWY, Ng SC, Inoue H, Reddy DN, Ling Hu E, Cho JY, et al. Practice of endoscopy during COVID-19 pandemic: Position statements of the asian pacific society for digestive endoscopy (APSDE-COVID statements). Gut 2020;69: 991-6.  Back to cited text no. 3
    
4.
World Health Organization. Modes of transmission of virus causing COVID-19 : Implications for IPC precaution recommendations. Scientifc Brief. Geneva: World Health Organization; 2000. Available at: https://www.who.int/newsroom/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations. Accessed 10 May 2020.  Back to cited text no. 4
    
5.
Tyng CJ, Bitencourt AG, Martins EB, Pinto PN, Chojniak R Technical note: CT-guided paravertebral adrenal biopsy using hydrodissection—A safe and technically easy approach. Br J Radiol 2012;85:e339-42.  Back to cited text no. 5
    
6.
Petrocelli F, Ierardi AM Response to: Interventional radiology and COVID-19: Evidence-based measures to limit transmission. Diagn Interv Radiol 2020;26:513.  Back to cited text no. 6
    


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