InLine Radiofrequency Ablation Research Articles

Hand-Assisted Laparoscopic Partial Nephrectomy: A Controlled Study of Bipolar Inline Radiofrequency Ablation Device in Swine

Bipolar inline radiofrequency ablation (ILRFA) is an effective way to control bleeding during parenchymal organ transection. This was investigated in a study of laparoscopic hand-assisted partial nephrectomy in swine. Nine Landrace pigs were divided between 2 groups; diathermy was employed in the control group for parenchymal transaction and ILRFA was applied in the experimental group through a hand-port and deployed into the resection plane. After complete coagulation, resection was performed using scissors. The mean intraoperative blood loss was 32 +/- 15 mL in the ILRFA group and 187 +/- 69 mL in the control group: a 82.9% reduction ( P = .015). The mean blood loss per resection area was 2.53 +/- 0.92 mL/cm(2) in the ILRFA group compared with 17.31 +/- 9.05 mL/cm( 2) in controls; the reduction was 85.4% (P = .005). ILRFA is effective in achieving reducing blood loss and provides a drier operative field for precise dissection.

INLINE BIPOLAR RADIOFREQUENCY ABLATION DEVICE-ASSISTED PARTIAL NEPHRECTOMY IN A PORCINE MODEL

Nephron-sparing surgery has become an acceptable alternative to radical nephrectomy in the treatment of renal tumours. Control of intraoperative blood loss can be an important challenge during partial nephrectomy. InLine radiofrequency ablation (ILRFA) device has shown promising results of significant reduction of intraoperative blood loss in liver resection. In this study, we tested ILRFA-assisted partial nephrectomy in a porcine model. Eight landrace pigs were used in this study. Every pig underwent 2-3 partial nephrectomies. The proposed line of parenchymal incision was circumferentially scored with a diathermy. Then, ILRFA was deployed into this resection plane. After complete coagulation, the resection was then simply carried out using the scalpel. For the control resection, we used diathermy to transect the other pole, further sutures were then used to secure the residual bleeding. The ILRFA deployments were set to 3 cm power algorithm. The average radiofrequency ablation coagulation time was 5 min. The mean intraoperative blood loss 35 +/- 7 mL in the ILRFA and 152 +/- 94 mL in the control, a 77.0% reduction (P = 0.024). The mean blood loss per centimetre of resection area was 2.09 +/- 1.41 mL/cm(2) in the ILRFA compared with 12.79 +/- 1.68 mL/cm(2) in controls; the reduction was 79.0% (P = 0.019). Our study indicates that ILRFA for partial nephrectomy in a porcine model is effective in reducing blood loss. Precoagulation before parenchymal transection appears to be a valid concept in nephron-sparing surgery.

NOVEL SURGICAL MANAGEMENT OF RENAL TRAUMA: INLINE RADIOFREQUENCY ABLATION COAGULATION

Renal injury accounts for 10% of all abdominal trauma. Low-grade renal injuries can be managed without surgery. However, patients with grade IV or grade V injuries may require nephrectomy. In this study, InLine radiofrequency ablation device (ILRFA), which we developed for liver surgery was tested in the animal model of simulated renal injury. A grade IV renal injury was induced in eight landrace pigs. Then treatment with ILRFA was compared to conventional diathermy and suture; totally 24 surgeries were carried out (12 ILRFA vs 12 control). No massive bleeding occurred and no animal died during the experiments. Immediately after surgery, the pigs were given euthanasia. The average of RFA coagulation time was 3.5 min. The mean intraoperative blood loss was 42 +/- 16 mL in the ILRFA and 195 +/- 58 mL in the control, a 78.5% reduction (P < 0.001). The mean blood loss per centimetre squared of resection area was 4.50 +/- 2.84 mL/cm(2) in the ILRFA compared with 18.73 +/- 6.89 mL/cm(2) in controls, the reduction was 76.0% (P = 0.001). InLine RFA is efficient for the management of haemorrhage in renal trauma in an animal model and deserves clinical evaluation.

A multicentre controlled study of the InLine radiofrequency ablation device for liver transection

Background. Surgical resection is the most effective therapy for liver cancer. Intraoperative blood loss during liver resection remains a major concern due to association with higher postoperative complications. The InLine radiofrequency ablation device (ILRFA) has achieved promising results in liver surgery with minimal blood loss and no increase of postoperative complications. In this multicentre controlled study, 108 patients undergoing liver resection were investigated. Patients and methods. A total of 108 patients underwent liver resections in 4 medical centres; the prospective sequential cohort study consisted of 54 ILRFA and 54 ultrasonic surgical aspirator transections as the control group. Results. The type of liver resection performed was very similar in both groups. The median number of RFA deployments was 3 (range 1–12) with a median coagulation time of 9 (range 3–36) min. Median blood loss was 165±20ml (range 5–675) in the ILRFA and 654±83ml (range 80–3600) in the control group (p<0.001). The median transection time was 27 (2–219) min in the ILRFA group and 35 (5–62) min in controls. Conclusions. Our study indicates that ILRFA device for liver transection is effective in reducing blood loss and is safe. Precoagulation before parenchymal transection appears to be a valid concept in liver surgery. The avoidance of vascular inflow occlusion during parenchymal transection could also be of value.

INLINE RADIOFREQUENCY ABLATION‐ASSISTED LAPAROSCOPIC LIVER RESECTION: FIRST EXPERIMENT WITH STAPLING DEVICE

In liver surgery, the increase in advancement of laparoscopic equipment has allowed the feasibility and safety of complex laparoscopic liver resection. However, blood loss and the potential risk of gas embolism seem to be the main obstacles. In this study, we successfully used the InLine radiofrequency ablation (RFA) device to carry out laparoscopic hand-assisted liver resection in pigs. Under general anaesthesia with tracheal intubation, pigs underwent InLine RFA-assisted laparoscopic liver resection. After installation of Hand Port and trocars, the InLine RFA device was introduced through Hand Port system and inserted into the premarked resection line. Then the generator was turned on and the power was applied according to the power setting. The resection was finally carried out using diathermy or stapler. For the control group, resection was simply carried out by diathermy or stapler. Eight Landrace pigs underwent 23 liver resections. Blood loss was reduced significantly in the InLine group (P<0.001) when compared with control group in both surgical methods (diathermy and stapler). In this study, we successfully carried out InLine RFA-assisted laparoscopic liver resection in both stapled and diathermy group. We showed that there was a highly significant difference between InLine and other liver resection techniques laparoscopically.

An experimental study of the treatment of liver injury with InLine RFA

Background: The liver is the most frequently injured abdominal organ after blunt injury; sometimes it may be very difficult to achieve haemostasis. In this study we examined the use of InLine radiofrequency ablation (RFA) for the coagulation and haemostasis of simulated liver injury. Materials and methods: Six pigs were tested in this study. We created two types of grade III to IV liver injury: peripheral and central. Then treatment with InLine RFA was compared to conventional diathermy and suture. A total of 32 surgeries were performed: peripheral injury (12 InLine versus 6 diathermy + suture); central injury (8 InLine versus 6 diathermy + suture). Results: The reduction of blood loss was 63.88% in peripheral injury and 53.57% in central injury, respectively. There were significant differences in both types of injuries as regards blood loss (p<0.05) and blood loss per cm2 (p<0.05). Conclusions: InLine RFA is efficacious in treating liver injuries in pigs and may have a significant potential for some human liver injuries.

A prospective study of in-line radiofrequency ablation in hepatic parenchymal transection – its efficacy and complications

AbstractBackground. Bleeding during liver transection remains a potential hazard. This study aims to report the efficacy and complications of in-line radiofrequency ablation (ILRFA)-assisted liver resection. Patients and methods. The blood loss of 25 consecutive patients who underwent ILRFA-assisted liver resection was obtained by weighing swabs and measuring suction jar contents during liver resection and calculated in ml per cm2 of the transection surface area. Postoperative complications were recorded. Five clinical variables, which might affect blood loss, were analyzed. Results. The mean blood loss during parenchymal dissection for the ILRFA group was 3.4±3.2ml/cm2. Three patients had intra-abdominal collections, including one patient with bile leakage after ILRFA-assisted liver resection. Age, gender, extent of liver resection, liver quality and Pringle maneuver did not demonstrate significant impact on blood loss. Conclusions. This study showed that ILRFA-assisted liver resection was associated with very low blood loss. This is likely to improve the operative safety of liver resection for hepatic tumors. There were no significant postoperative sequelae.

In-line radiofrequency ablation to minimize blood loss in hepatic parenchymal transection

Background Intraoperative blood loss has been shown to be an important factor correlating with morbidity and mortality in liver surgery. A 5-cm long instrument with variably deployable metal electrodes using in-line radiofrequency ablation (ILRFA) energy was used for hepatic transection in an attempt to reduce bleeding. Methods Eight patients underwent liver resection. At each resection, half the resection was performed with ILRFA and the other half was performed with an ultrasonic aspirator alone. Blood loss was measured for each mode of resection. Results The mean blood loss using ILRFA was 6.5 (±3.7) mL/cm 2 compared with 20.4 (±8.7) mL/cm 2 by using the ultrasonic aspirator ( P = .004). Conclusions In-line radiofrequency ablation reduced bleeding during hepatic parenchymal transection when compared with the ultrasonic aspirator.

Controlled Study of In-Line Ovine Spleen Transection Assisted by Radiofrequency Ablation

Trauma to the spleen or tumors of the spleen often require total splenectomy for control of hemorrhage. Partial splenectomy is the preferred technique because of the short- and long-term sepsis problems in asplenic patients. Multiple techniques for partial splenectomy have been tried in the past with limited success. The authors designed the in-line radiofrequency ablation (ILRFA) probe for liver surgery. It uses radiofrequency energy to make a linear coagulative plane that allows the parenchyma of solid vascular organs to be divided. In this study, for the first time, the efficiency of ILRFA was tested with the ovine spleen. Seven sheep were used for this study. With the sheep under general anesthesia, a laparotomy was performed. The first sheep was used for a pilot study. Eight partial splenectomies were made in the remaining six sheep using ILRFA. For a control, a matching partial splenectomy was made in each sheep using diathermy and sutures. Blood loss was measured by determining the difference in the weights of dry sponges and blood-stained sponges after resection. A paired t test was used to compare the bleeding between the control and the ILRFA techniques. The mean blood loss was 33.14 +/- 17 g using ILRFA and 123.43 +/- 72 g in the control group. The bleeding was significantly reduced in the ILRFA group (p = 0.0056). The time required to apply ILRFA was 12 minutes. Partial splenectomy was achieved in the ovine spleen using radiofrequency energy with minimal blood loss.

Controlled study of Inline radiofrequency ablation (ILRFA) assisted transection of ovine liver

Liver resection is now a standard treatment for primary and secondary hepatic tumors around the world. Intra-operative blood loss during liver resection is a major factor associated with morbidity and mortality. We have developed a new instrument using radiofrequency energy (ILRFA), which is intended to achieve coagulative ablation in a plane. This plane can then be cut through with a scalpel, ultrasonic dissector, or diathermy with minimal blood loss. Five sheep were used in this non-recovery experiment. In these sheep we performed five liver resections with the ILRFA and five similar resections using diathermy and suturing as control. Blood loss was measured by determining the difference in the weights of dry sponges and blood stained sponges after resection. ILRFA was successful in achieving coagulative ablation in all cases to a width of 1 cm. The mean blood loss in ILRFA was 43.2 g (SD36) and 221.8 g (SD147) in the control group. The bleeding was significantly reduced in ILRFA group with a P value of 0.005. Bleeding remains an important complication of liver resection. To reduce bleeding during liver surgery, different techniques have been used. In this study, we have demonstrated that by using ILRFA we can perform liver resections in sheep with minimal blood loss.

Novel in-line multielectrode radiofrequency ablation considerably reduces blood loss during liver resection in an animal model.

Liver resection is widely used in the treatment of primary and secondary liver tumours. One of several important factors associated with mortality both in cirrhotic and non-cirrhotic patients after liver resection is operative blood loss. We evaluated the use of a prototype radiofrequency ablation probe to treat the transection plane prior to liver resection in the sheep model. In-line radiofrequency ablation (RFA) was performed on the liver using a prototype device consisting of 11 electrodes mounted on a 8-cm base. The RITA 1500 generator was used for power delivery. Ultrasonic aspirator (UA) and clamp resection were performed on the liver of sheep with and without in-line RFA. The blood loss was measured by weighing swabs. A total of 26 liver resections were performed. The mean (SD) blood loss with UA resection was 0.032 g (0.011) versus 0.005 (0.005) g without and with prior in-line RFA, respectively (P = 0.001). The mean (SD) blood loss with clamp resection was 0.087 (0.10) g versus 0.01 (0.008) without and with in-line RFA, respectively (P = 0.155). In-line RFA makes liver resection easier with minimal blood loss and may make cirrhotic liver resection easier with minimal blood loss. This is likely to improve the operative safety of liver resection.