Small ablation zones created previous to saline infusion result in enlargement of the coagulated area during perfusion RF ablation: an ex vivo experimental study

Abstract

One of the strategies for enlarging coagulation zone dimensions during RF ablation of liver tumours is to infuse saline solutions into the tissue during ablation. The aim of this study was to evaluate experimentally whether the creation of a small coagulation adjacent to a bipolar RF applicator and prior to perfused RF ablation would allow enlargement of the coagulation zone. Thirty bipolar RF ablations (group A, n = 15; group B, n = 15) were performed in excised bovine livers. Additionally, in group B a monopolar RF application (60 W, 20 s) was performed before bipolar ablation using three small additional electrodes. Electrical parameters and dimensions of the ablation zone were compared between groups. Despite the fact that all three ablation zone diameters were greater in group B, only one of the minor diameters was significantly longer (5.52 ± 0.66 cm versus 4.87 ± 0.47 cm). Likewise, volume was significantly bigger in group B (100.26 ± 24.10 cm3 versus 79.56 ± 15.59 cm3). There were no differences in the impedance evolution, allowing a relatively high constant power in both groups (around 90 W). The efficacy of delivering energy (expressed as the delivered energy per coagulation volume) was significantly better in group B, showing a lower value (578 J cm−3 versus 752 J cm−3). These results suggest that the creation of small ablation zones prior to saline infusion improves the performance of this perfusion system, and hence the total volume.