Background: Thermal ablation of lung tumors adjacent to the mediastinum, chest wall and diaphragm carries risk of injury to critical structures. A technique for infiltration of the pleural space with gas is described, permitting separation of lung ablation targets from vulnerable adjacent structures and allowing subsequent safe ablation.

Methods: Retrospective review of 7 cases. A Veress needle was introduced to the pleural space and gas was insufflated. Intermittent CT scans were obtained to evaluate adequacy of pleural insufflation and the separation of the target lesion from adjacent critical structures. Thermal ablation was performed. Pleural gas was aspirated at the conclusion of each case.

Results: Creation of a pneumothorax sufficient to separate the ablation target from adjacent lung, mediastinal or chest was structures was achieved in 4 cases. In three patients with history of prior radiation or thoracic surgery, adequate pleural insufflation could not be achieved.

Conclusions: : In patients without prior radiation or chest surgery, use of the Veress needle to insufflate the pleural space permits creation of safe windows for thermal ablation of lung tumors in close proximity to mediastinum, chest wall and diaphragm.