For the same delivered energy, the new protocol significantly increases the magnitude of the applied electric field, which may be the reason why it is clinically more effective in achieving pain relief.

Purpose: To improve the computer modelling of radiofrequency ablation (RFA) by internally cooled wet (ICW) electrodes with added clinically oriented features. Methods: An improved RFA computer model by ICW electrode included: (1) a realistic spatial distribution of the infused saline, and (2) different domains to distinguish between healthy tissue, saline-infused tumour, and non-infused tumour, under the assumption that infused saline is retained within the tumour boundary. A realistic saline spatial distribution was obtained from an in vivo pig liver study. The computer results were analysed in terms of impedance evolution and coagulation zone (CZ) size, and were compared to the results of clinical trials conducted on 17 patients with the same ICW electrode. Results: The new features added to the model provided computer results that matched well with the clinical results. No roll-offs occurred during the 4-min ablation. CZ transversal diameter (4.10 ± 0.19 cm) was similar to the computed diameter (4.16 cm). Including the tumour and saline infusion in the model involved (1) a reduction of the initial impedance by 10 À 20 X, (2) a delay in roll-off of 20 s and 70 À 100 s, respectively, and (3) 18 À 31% and 22 À 36% larger CZ size, respectively. The saline spatial distribution geometry was also seen to affect roll-off delay and CZ size. Conclusions: Using a three-compartment model and a realistic saline spatial distribution notably improves the match with the outcome of the clinical trials. ARTICLE HISTORY

Radiofrequency energy has been used both experimentally and clinically to manage the pancreatic remnant after distal pancreatectomies. Our goal was to determine whether endoluminal radiofrequency (RF) ablation of the main pancreatic duct in large animals would be more efficient than glue occlusion as an exocrine pancreatic atrophy-inducing procedure. Thirty-four Landrace pigs were assigned to either the transpapilar (n = 16) or transection (n = 18) groups. The transection implied the pancreas neck was severed. In each of these groups the remaining distal pancreatic duct was occluded either by RF or by glue. In the transpapilar group complete atrophy was observed in all the RF cases, while atrophy was incomplete in all the members of the glue subgroup. The failure rate of the main pancreatic duct (usually expressed by a pseudocyst) in the transection groups was dramatically higher in the glue subgroup than the RF subgroups (9 out of 9 and 1 out of 9, respectively) and postoperative mortality occurred only in the glue subgroup (3 out of 9). These results show the superiority of endoluminal RF ablation over glue for main pancreatic duct occlusion, as seen by the degree of atrophy and fewer postoperative pancreatic fistulas.

Background and Objectives: Radiofrequency (RF)induced ablation can be carried out inside ducts and vessels by simultaneously dragging a bipolar catheter while applying RF power. Our objective was to characterize the relation between pullback speed, impedance progress, and temperature distribution. Study Design/Materials and Methods: We built a numerical model including a bipolar catheter, which is dragged inside a duct while RF power is applied between a pair of electrodes. The model solved a triple-coupled electrical, thermal, and mechanical problem. Lesions were assessed by an Arrhenius model. The numerical model's thermal and electrical characteristics were chosen to obtain the same initial impedance value as in the experiments: 560 Ω at 16°C (sample temperature). Results: The catheter initially remained still, and the impedance was falling during the application of power. When pullback speed was too slow (<0.4 mm/s) impedance continued to drop when the catheter began to move, creating deep lesions, overheating and impedance roll-off, while at the faster speed (0.4-1.0 mm/s) impedance first rose slightly and then reached a plateau. There was a strong inverse relation between pullback speed and lesion depth. The hottest point was always around the second electrode, creating a kind of hot wake. Conclusions: These findings confirm the close relationship between pullback speed and impedance progress, and suggest that the latter factor could be used to guide the procedure and achieve effective and safe ablations along the inner path of a duct or vessel. Lasers Surg. Med.

Introduction: Endoluminal sealing of the pancreatic duct by glue or sutures facilitates the management of the pancreatic stump. Our objective was to develop a catheter-based alternative for endoluminal radiofrequency (RF) sealing of the pancreatic duct. Materials and methods: We devised a novel RF ablation technique based on impedance-guided catheter pullback. First, bench tests were performed on ex vivo models to tune up the technique before the in vivo study, after which endoluminal RF sealing of a $10 cm non-transected pancreatic duct was conducted on porcine models using a 3 Fr catheter. After 30 days, sealing effectiveness was assessed by a permeability test and a histological analysis. Results: The RF technique was feasible in all cases and delivered $5 W of power on an initial impedance of 308 ± 60 X. Electrical impedance evolution was similar in all cases and provided guidance for modulating the pullback speed to avoid tissue sticking and achieve a continuous lesion. During the follow-up the animals rate of weight gain was significantly reduced (p < 0.05). Apart from signs of exocrine atrophy, no other postoperative complications were found. At necropsy, the permeability test failed and the catheter could not be reintroduced endoluminally, confirming that sealing had been successful. The histological analysis revealed a homogeneous exocrine atrophy along the ablated segment in all the animals. Conclusions: Catheter-based RF ablation could be used effectively and safely for endoluminal sealing of the pancreatic duct. The findings suggest that a fully continuous lesion may not be required to obtain complete exocrine atrophy.

No abstract

I am especially grateful for all those wonderful people that I have had the privilege to befriend. Their moral support, joy and care were a constant source of inspiration and motivation. Finally, above all, I am thankful to my Almighty God who deserves all glory, honor and power, and who keeps surprising me with His continuous blessings.