Hydrodissection and programmed stop sedation in 100 % of benign thyroid nodules treated with radiofrequency ablation

Souza, Katia Pinheiro de; Rahal, Antônio; Volpi, Erivelto; Falsarella, Priscila Mina; Hidal, Jairo Tabacow; Andreoni, Danielle M.; Neto, Miguel José Francisco; Queiroz, Marcos Roberto Gomes de; Garcia, Rodrigo Gobbo

doi:10.1016/j.ejrad.2020.109354

Cited by 5 publications

(4 citation statements)

References 29 publications

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“…All patients were submitted to ablative treatment in a supine position with neck extension and were placed under local anesthesia with programmed stop sedation. 4 The iceberg technique consisted of a two-stage treatment. Both began with the identification of the “danger triangle” zone, which included the recurrent laryngeal nerve and the esophagus.…”

Section: Techniquementioning

confidence: 99%

“… 3 Regarding this situation, radiofrequency thermal ablation (RFA) emerges as a valuable option, allowing minimally invasive treatment and preserving thyroid function in selected patients. 4 Since thyroid RFA is entirely guided by ultrasound (US), in diving thyroid nodules, just the cervical portion (the peak of the iceberg) is visible on the US, and the presence of a mediastinal immersion component that cannot be identified by the method may be a limitation to the safe treatment of these nodules. We describe a new technique, the iceberg technique, to overcome this issue and a three-year single-center experience using this approach.…”

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confidence: 99%

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The iceberg technique: an innovative approach for radiofrequency ablation of diving thyroid nodules

Rahal¹,

Volpi²,

Schmid³

et al. 2023

dir

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Diving thyroid nodules are a limitation of radiofrequency ablation because the mediastinal component cannot be adequately identified by ultrasound (US). We aim to describe a new technique, the iceberg technique, to overcome this issue and explain our three-year experience of using this novel method. The iceberg technique consists of a two-stage treatment. First, the ablation of the cervical portion of the nodules (easily visualized during the initial US exam) using trans-isthmic access is performed using the moving-shot technique. After three to six months, there is a volumetric reduction of the treated portion, leading to retraction of the thyroid parenchyma. This brings the mediastinal component to the cervical region, thereby enabling a perfect visualization by US. Then, the second stage of treatment is carried out with complete nodule ablation, and the region that was treated first is looked at a second time. From April 2018 to April 2021, nine patients with nine benign nodules were submitted for the iceberg technique. No complications occurred during the entire follow-up period. The patients displayed normal hormonal levels after the procedures, and there was a significant volume reduction of the nodules until three months post-ablation. The iceberg technique is an effective and safe option for the radiofrequency treatment of diving goiters.

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Section: Techniquementioning

confidence: 99%

mentioning

confidence: 99%

The iceberg technique: an innovative approach for radiofrequency ablation of diving thyroid nodules

Rahal¹,

Volpi²,

Schmid³

et al. 2023

dir

Self Cite

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“…One is the pre-tracheal fascia (false capsule), derived from the deep cervical fascia layer, and the second is the capsule formed through peripheral condensation of the glandular thyroid tissue (true capsule) (10). Previous hydrodissection techniques have been performed beyond the pre-tracheal fascia (false capsule) (7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

“…According to a recent guideline, " hydrodissection creates distance between the target lesion and vital structures, minimizing patient discomfort and reducing unintended thermal spread" (6). In previously described hydrodissection techniques, sterile water or 5% dextrose was injected between the thyroid nodules and surrounding tissues until the nodules and surrounding tissues were completely separated (2-5 mm between nodules and surrounding tissues) (7)(8)(9). There are two capsules surrounding the thyroid.…”

Section: Introductionmentioning

confidence: 99%

Microwave ablation of benign thyroid nodules: the importance of modified hydrodissection

kucukay,

acu,

subasi

2023

Preprint

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Purpose: To evaluate the safety and efficacy of microwave ablation (MWA) in treating benign thyroid nodules and any advantage of modified hydrodissection (MHD) techniques while performing these procedures. Materials and Methods: This retrospective study included 76 consecutive patients treated for benign thyroid nodules using MWA. Patients were divided into two groups. Group 1 included patients treated before November 2019 using the HD technique (n=38), and group 2 included patients treated using the MHD technique after November 2019 (n=38). HD-MHD was performed using 5% dextrose. A portable MWA device with a 2450 MHz frequency was used as the generator. MWA antennas with internal water-cooled units and temperature monitoring features with a 16G diameter, 100 cm body length, and 3 mm tip length were used for MWA procedures. Color Doppler ultrasound examinations, thyroid function tests, volume reduction ratios (VRR), visual analog scales, and cosmetic scores were performed on the patients in the first, third, sixth, and every sixth months after ablation procedures. Complications and procedure times were also recorded. Results: No significant differences in VRR, visual analog scale, or cosmetic score were observed between the groups at 3, 6, and 12 months. Lower complication rates ( 26.31% vs. 7.89%, p=0.03) and procedure times (10.30 min vs. 7.30 min; p=0.04) were observed with the MHD technique. There were no residual or recurrent nodules or thyroid hormone deficiencies during the follow-up. Conclusion: MWA of benign thyroid nodules is safe and effective. Using the MHD technique lowers complication rates and procedure time.

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Different effects of intravenous and local anesthesia in patients undergoing ultrasound-guided radiofrequency ablation of thyroid nodules: a prospective cohort study

Gao

Ya-lin

Tong

et al. 2022

International Journal of Hyperthermia

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Hydrodissection and programmed stop sedation in 100 % of benign thyroid nodules treated with radiofrequency ablation

Cited by 5 publications

References 29 publications

The iceberg technique: an innovative approach for radiofrequency ablation of diving thyroid nodules

The iceberg technique: an innovative approach for radiofrequency ablation of diving thyroid nodules

Microwave ablation of benign thyroid nodules: the importance of modified hydrodissection

Different effects of intravenous and local anesthesia in patients undergoing ultrasound-guided radiofrequency ablation of thyroid nodules: a prospective cohort study

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