Radiofrequency hepatic ablation with internally cooled electrodes and hybrid applicators with distant saline infusion using an in vivo porcine model

Abstract

Aims Radiofrequency ablation (RFA) of tumors by means of internally cooled (ICE) or multitined expandable electrodes combined with infusion of saline into the tissue may improve results. Our aim was to determine the efficacy of a previously optimized hybrid ICE system (ICE combined with infusion of saline into the tissue at a distance of 2 mm) in comparison with a conventional ICE cluster electrode in porcine liver in vivo. Methods A total of 32 RFA were performed on a total of 10 farm pigs using two RFA systems: Group A ( n = 16): Cluster electrode. Group B ( n = 16): Hybrid system (with continuous infusion of 100 ml/h of 20% NaCl at 2 mm distance from the electrode shaft by an independent isolated needle). Livers were removed for macroscopic and histological assessment after the procedure. Coagulation volume, coagulation diameters, coefficient of variability (CV) of coagulation volume, sphericity ratio (SR), deposited power (DP), deposited energy (DE), deposited energy per coagulation volume (DEV) and rise of animal temperature during the procedure were compared and correlated among groups. Additionally, linear regression analysis was modeled to study the relationship between deposited energy and either coagulation volume and rise of animal temperature during the procedure in both groups. Results Both coagulation volume and short diameter of coagulation were significantly greater ( p < 0.05) in group B compared to group A (22.7 ± 11.0 cm 3 and 3.1 ± 0.7 cm vs. 13.5 ± 7.7 cm 3 and 2.5 ± 0.5 cm, respectively). A similar CV and SR was observed among groups (57.1% and 1.4 ± 0.3 vs. 48.6% and 1.3 ± 0.2 for groups B and A, respectively). In group B, DE and DP were more than double group A, but DEV was nearly twice as high (9782 J/cm 3 vs. 5342 J/cm 3, for groups B and A, respectively). No significant relationship between DE and coagulation volume was encountered. Conclusion Efficacy of a single ICE may be improved with continuous infusion of saline at around 2 mm from the electrode shaft. Coagulation volume obtained with this improved system may be even greater than that obtained with a cluster electrode.