Laparoscopically guided bipolar radiofrequency ablation of areas of porcine liver

Curley, Steven A.; Davidson, Bradley S.; Fleming, Rachel; Izzo, Francesco; Stephens, L. Clifton; Tinkey, Peggy T.; Cromeens, Douglas M.

doi:10.1007/s004649900437

Cited by 88 publications

(52 citation statements)

References 27 publications

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“…Finally, RFA can be used to treat patients with a solitary hepatic tumor in a location that precludes a margin-negative hepatic resection, such as a tumor nestled between the inferior vena cava (IVC) and the entrance of the three hepatic veins into the IVC ( Figure 6). Our group Radiofrequency Ablation of Liver Tumors has successfully treated tumors abutting major hepatic or portal vein branches because the blood flow acts as a heat sink that protects the vascular endothelium from thermal injury while allowing complete coagulation of tissue immediately surrounding the blood vessel wall [23]. The only area of the liver I avoid treating with RFA is the hilar plate where the portal vein and hepatic arterial branches enter the liver.…”

Section: Indications For Rfa Of Liver Tumorsmentioning

confidence: 99%

“…The inflow occlusion increases the size of the zone of coagulative necrosis and Curley 19 enhances the likelihood of complete tumor cell kill, even if the tumor abuts a major intrahepatic blood vessel. Our previous preclinical work demonstrated that RFA treatment combined with vascular inflow occlusion can produce complete circumferential necrosis of tissue around major portal or hepatic vein branches without damaging the integrity of the vessel wall [23]. Another reason we frequently choose an open approach is the ability to combine resection of tumors too large to ablate in one lobe with RFA of smaller tumors in the opposite lobe.…”

Section: Rfa Treatment Approachesmentioning

confidence: 99%

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Radiofrequency Ablation of Malignant Liver Tumors

2001

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The majority of patients with primary or metastatic hepatic tumors are not candidates for resection because of tumor size, location near major intrahepatic blood vessels precluding a margin-negative resection, multifocality, or inadequate hepatic function related to coexistent cirrhosis. Radiofrequency ablation (RFA) is an evolving technology being used to treat patients with unresectable primary and metastatic hepatic cancers. RFA produces coagulative necrosis of tumor through local tissue heating. Liver tumors are treated percutaneously, laparoscopically, or during laparotomy using ultrasonography to identify tumors and guide placement of the RFA needle electrode. For tumors smaller than 2.0 cm in diameter, one or two deployments of the monopolar multiple array needle electrode are sufficient to produce complete coagulative necrosis of the tumor. However, with increasing size of the tumor, there is a concomitant increase in the number of deployments of the needle electrode and the overall time necessary to produce complete coagulative necrosis of the tumor. In general, RFA is a safe, well-tolerated, effective treatment for unresectable hepatic malignancies less than 6.0 cm in diameter. Effective treatment of larger tumors awaits the development of more powerful, larger array monopolar and bipolar RFA technologies.

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Section: Indications For Rfa Of Liver Tumorsmentioning

confidence: 99%

Section: Rfa Treatment Approachesmentioning

confidence: 99%

Radiofrequency Ablation of Malignant Liver Tumors

2001

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“…[5] To overcome the drawback of monopolar RFT, various techniques and modes have been proposed, including multiple probes RFT applied in the form of either simultaneous [6] or alternative RFT, [7] and bipolar RFT. [8][9][10][11] However, to date, as far as we know, there is no published data evaluating the efficiency of RFT for the treatment of lower extremity ischemic pain and compare the effectivity of monopolar RFT and bipolar RFT mode.…”

Section: Introductionmentioning

confidence: 99%

Radiofrequency termocoagulation for the treatment of lower extremity ischemic pain: Comparison of monopolar and bipolar modes

Destegül¹,

Işik²,

Özbek³

et al. 2017

Agri

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SummaryObjectives: Radiofrequency thermocoagulation (RFT) has been reported to be used safely to treat ischemic lower extremity pain. The objective of the present study was to evaluate efficiency of RFT for treatment of lower extremity ischemic pain and to compare effectiveness of monopolar RFT and bipolar RFT modes. Methods: Following ethics committee approval, 30 American Society of Anesthesiologists classification I-III patients with ischemic lower extremity pain aged between 18 and 65 years were recruited. Patients were randomly allocated into 2 groups: MRT group (n=15) received monopolar RFT (80°C) for 2 minutes at L2-3 level, and BRT group (n=15) received bipolar RFT (80°C) for 2 minutes at L2-3 level. Systolic and diastolic blood pressure, heart rate, pain score, and supplemental analgesic requirements were recorded at 24 hours after application and at 7, 30, and 90 days. Results: Numerical rating scale values in both groups decreased significantly over time and it was found to be significantly lower in BRT group after first and third months (p<0.05). Supplemental analgesic requirements were similar with no significant difference between the 2 groups at any point of study period (p>0.05). No adverse event or complication related to procedure or treatment was reported. Conclusion: In patients with ischemic lower extremity pain, both monopolar and bipolar RFT treatment modalities were found to significantly decrease pain levels. However, bipolar mode led to lower pain scores at 30 and 90 days, and longer duration of analgesia than monopolar mode.Keywords: Radiofrequency thermocoagulation; monopolar; bipolar; ischemic pain; lumbar sympatholysis. ÖzetAmaç: Alt ekstremitenin iskemik ağrı tedavisi için radyofrekans termokoagülasyon'un (RFT) güvenle kullanılabileceği bildirilmiştir. Bu çalışmanın amacı alt ekstremitenin iskemik ağrı tedavisi için RFT'un etkinliğini değerlendirmek ve monopolar ve bipolar RFT modlarını karşılaştırmaktı. Gereç ve Yöntem: Etik komite kabulünü takiben alt ekstremite iskemik ağrısı olan, yaşları 18-65 yaş arası, ASA I-III grubu, 30 hasta çalışmaya alındı. Hastalar MRT grubunda (n=15) L 2-3 düzeyinden 2 dakika monopolar RFT (80°C), BRT grubunda (n=15) ise L 2-3 düzeyinden 2 dakika bipolar RFT (80°C) almak üzere rastgele iki gruba ayrıldı. Sistolik ve diastolik kan basınçları, kalp atım hızı, ağrı skorları (NRS) ve ek analjezik ihtiyaçları hastaneden taburcu edildikten 24 saat ve 7, 30 ve 90. günlerde kaydedildi. Bulgular: Her iki grupta NRS skorlarının zaman içerisinde önemli derecede azaldığı ve BRT grubunda MRT grubuna göre 30 ve 90. günlerde istatistiksel olarak önemli derecede daha düşük olduğu tespit edildi (p<0.05). Bununla birlikte, ek analjezik ihtiyacının iki grupta benzer olduğu ve iki grup arasında çalışma periyodlarında istatistiksel fark oluşturmadığı tespit edildi (p>0.05). İşlem veya tedaviye ilişkin yan etki veya komplikasyon bildirilmedi. Sonuç: Alt ekstremitenin iskemik ağrı tedavisinde hem monopolar hem de bipolar radyofrekans termokoagülasyon tedavi modalitelerinin ...

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“…Surgical resection offers the best chance of long-term survival, but is rarely possible. In many patients with cirrhosis or multiple tumors hepatic reserve is inadequate to tolerate resection and alternative means of treatment that target the tumor, but preserve uninvolved liver are necessary [2]. Cryoablation and RF ablation are the most commonly used therapies for cases where surgical resection is not possible.…”

Section: Introductionmentioning

confidence: 99%

“…Inflow occlusion however requires a major surgical procedure, which negates one of the major advantages of RF ablationuse in a minimally invasive procedure (percutaneous or laparoscopic). Bipolar RF ablation has been shown to create larger lesions using two needle electrodes, compared to conventional ablation using a single needle electrode, when the two probes are placed close to each other [2]. There have been no investigations of methods other than bipolar ablation that allow usage of multiple RF probes simultaneously.…”

Section: Introductionmentioning

confidence: 99%

Multiple probe hepatic radio-frequency ablation: ex-vivo experiments in the porcine model

Haemmerich

Webster

Lee

et al.

2001 Conference Proceedings of the 23rd Annual International Conference of the IEEE Engineering in Medicine and Biology Society

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Abstract-Radio-frequency (RF) ablation is an important means of treatment of non-resectable primary and metastatic liver tumors. The RF ablation of any but the smallest tumor requires the use of multiple overlapping treatment zones. Commercially available RF ablation generators, unlike cryoablation (a method of tumor destruction that utilizes cold rather than heat), are only capable of driving a single RF probe at a time. Using multiple probes simultaneously in RF ablation is desirable for treating large tumors and for treating multiple tumor metastases. Bipolar RF ablation, which has been previously studied by other groups, allows simultaneous usage of two probes. The energy converted to heat at each probe for bipolar RF ablation is necessarily equal. There have been no investigations of other methods that allow usage of multiple RF probes simultaneously. We investigate feasibility of a new method, where power is applied in an alternating fashion between two or more probes. This method allows independent control of the amount of energy deposited at each probe. We performed ex-vivo experiments with one (i.e. conventional ablation) and with two probes. In the two-probe experiment, both probes reached target temperature and created lesions of sizes comparable to conventional RF ablation.

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Laparoscopically guided bipolar radiofrequency ablation of areas of porcine liver

Cited by 88 publications

References 27 publications

Radiofrequency Ablation of Malignant Liver Tumors

Radiofrequency Ablation of Malignant Liver Tumors

Radiofrequency termocoagulation for the treatment of lower extremity ischemic pain: Comparison of monopolar and bipolar modes

Multiple probe hepatic radio-frequency ablation: ex-vivo experiments in the porcine model

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