Abstract
(1) Background: Preclinical and clinical data about a novel radiofrequency ablation (RFA) system (STARmed Co, Ltd.; Koyang, Korea) designed to be used under endoscopic ultrasound (EUS) control for pancreatic lesion ablation, are limited, obtained with non-standardized procedures and heterogeneous results. The aim of this study is to standardize the RFA procedure of this system in order to define the optimal ablation power and time. (2) Methods: RFA was performed on an ex-vivo porcine liver at different powers (40, 30, 20, 10 Watts (W)) and times (1, 3, 5, 7, 15 min) with a 1-centimeter monopolar electrode (perfused by chilled solution) positioned on the distal tip of a 19-Gauge needle. A blinded expert pathologist histologically analyzed each ablation area. (3) Results: The size of the total macroscopic ablated area was negatively correlated with ablation power (R −0.74): the largest was obtained at 10 W (p = 4.7 × 10−4) for longer times (R 0.92; p = 8.9 × 10−8). Central histologic coagulative necrosis did not differ among ablation settings (mean size 3.25 mm). External “parenchymal hypochromia” or “diaphanization” resulted the widest at 10 W, for longer times (R 0.8, p = 3.6 × 10−4). (4) Conclusions: The RFA system can produce small sizes of coagulative necrosis, regardless of the setting. Larger areas of diaphanization surrounding the necrosis can be produced at lower powers for longer times.
Highlights
Radiofrequency ablation (RFA) is a minimally invasive technique widely applied in clinical practice for the treatment of parenchymal tumors, obtaining a thermal-induced coagulative necrosis [1,2].due to the thermal effect, the application of RFA on pancreatic tumors carries an important risk of injury of the surrounding structures, like the common bile duct, the duodenum and the pancreas itself, with the potential risk of acute pancreatitis
(3) Results: The size of the total macroscopic ablated area was negatively correlated with ablation power (R −0.74): the largest was obtained at 10 W (p = 4.7 × 10−4) for longer times (R 0.92; p = 8.9 × 10−8)
Different RFA tests were conducted on ex-vivo porcine livers from male animals at least after 48 h from animal explant, as previously performed for the evaluation of another RFA plus cryoablation probe usable under the endoscopic ultrasound (EUS) guide [12,13]
Summary
Radiofrequency ablation (RFA) is a minimally invasive technique widely applied in clinical practice for the treatment of parenchymal tumors, obtaining a thermal-induced coagulative necrosis [1,2]. Due to the thermal effect, the application of RFA on pancreatic tumors carries an important risk of injury of the surrounding structures, like the common bile duct, the duodenum and the pancreas itself, with the potential risk of acute pancreatitis. Available probes differ based on their application, whether employed for surgical or endoscopic pancreatic RFA. These are designed to obtain a spherical area of ablation, with an extension influenced by the thermal efficiency of the delivery system and by intrinsic tissue factors, such as tissue impedance or “resistive heating” and the “heat-shrink” effect [3,4].
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