The modern use of radiofrequency energy in surgery, endoscopy and interventional radiology

Abstract

BACKGROUND: The potential applications of radiofrequency (RF) energy in medicine are an expanding field. This paper describes the development and early results of the application of four novel radiofrequency devices in surgery, endoscopy and interventional radiology. METHODS: The four devices that were designed and have been assessed were 1) Endoblate: a bipolar RF catheter for endoscopic use which was assessed in patients with rectal tumors, 2) Hexablate: a bipolar RF ablation/aspiration device which was used to treat liver cancers, 3) VesCoag: a bipolar RF catheter for endovascular ablation which was used by interventional radiologists to seal the blood vessels of tumors within the liver and 4) EndoHPB: an endoscopic bipolar RF catheter for endobiliary ablation which so far has been assessed in a porcine model. RESULTS: In the pilot clinical studies on Endoblate, Hexablate and VesCoag, all the devices could be used in the clinical situation for which they had been designed. There were no technical problems and no serious adverse events associated with their use. All were used in bipolar mode apart from VesCoag, where it was found that a monopolar current was required for effective vessel sealing. For EndoHPB in the porcine model, it was determined that the ideal power setting was 5–10 watts for 2 min. A clinical trial is to be undertaken to determine whether this power setting is applicable for when EndoHPB is used in the management of malignant obstructive jaundice. CONCLUSIONS: It is an exciting time in the development of new RF instruments, and as they become more sophisticated their clinical applications will expand. These early data from the animal and pilot clinical studies are promising and larger studies with longer term follow-up needs to be undertaken to establish their true clinical worth.