Radiofrequency-induced Thermotherapy Research Articles

Bipolar radiofrequency-induced thermotherapy of haemorrhoids: a 10-year experience

Bipolar radiofrequency-induced thermotherapy of haemorrhoids: a 10-year experience

Transoral radiofrequency of the terminal branches of the recurrent nerve in the treatment of adductor spasmodic dysphonia: our experience over 11 patients.

Spasmodic dysphonia (SD) or laryngeal dystonia is as a rare vocal disorder characterized by involuntary action-induced endolaryngeal contraction. In the last decade, botulin toxin injection has become the standard treatment in adductor spasmodic dysphonia necessitating repetitive injections. The purpose of this study is to analyze retrospectively data from patients treated with the minimal-invasive transoral radiofrequency-induced thermotherapy (RFITT) of the terminal branches of the recurrent nerve. Between 2009 and 2015, 11 patients (six females and five males aged from 32 to 91years) with adductor SD were treated with RFITT. Pre-operative and post-operative vocal assessments (VHI-30, GRBASI, and acoustic-aerodynamics measurements), number of surgical revisions, delay between procedures, and post-operative complications were recorded. Statistical analyses were carried out on the first vocal assessment performed 2-8weeks after the first procedure. Based on available data from ten patients, voice handicap index (VHI) showed improvement with a mean value of -17.7 points (p-value (pval) = 0.014, adjusted p-value (adj pval) = 0.21); instability has also revealed improvement in six patients (pval = 0.05, adj pval = 0.31). Four patients underwent only one procedure including one patient showing still long-term beneficial results after 5years of follow-up. Other patients required one to three new procedures with an average time between procedures of 15.3months. Over 24 surgeries performed on a total of 11 patients, one definitive treatment-related severe adverse event was reported. Thanks to long-lasting effect, repetitive treatments are less frequent compared to botulin toxin therapy. In our opinion, RFITT is a promising alternative to botulin toxin as a second-step procedure in case of toxin resistance or patient's lack of compliance.

Pattern of thermal damage and tissue carbonisation from endovenous radiofrequency ablation catheter - Using an in vitro porcine liver model.

Successful endovenous thermoablation relies on transmural vein wall ablation. We investigated the pattern of thermal spread and tissue carbonisation from RadioFrequency-induced ThermoTherapy (RFiTT) at different powers and pull back methods, using a porcine liver model. We used a previously validated in-vitro porcine liver model. Different powers from 5-25 W were used to administer 150 J. We compared continuous and pulsed energy delivery. Length, lateral spread, and total area of thermal damage, together with any tissue carbonisation, was measured using digital analysis software. All experiments used 150 J total energy. Total thermal damage area was smaller with lower power and pulsed energy. Continuous energy caused more tissue carbonisation than pulsed except at 25 W. Reduced thermal damage with lower power or pulsed energy results from cooling due to increased time of treatment. Increasing the power increases tissue carbonisation. Optimal treatment is determined by the highest power used continuously that does not cause tissue carbonisation.

One Stage Multilevel Surgery for the Treatment of Obstructive Sleep Apnea Syndrome

Obstructive sleep apnea syndrome (OSAS) is a very frequent and increasingly recognized major health problem [1]. OSAS may result in cardiovascular diseases, quality of life deficits and performance deficits from loss of alertness [2-5]. Nasal continuous positive airway pressure (CPAP) is considered the gold standard for the primary treatment of moderate to severe OSAS [6]. However, the therapeutic use of nasal CPAP is seriously limited by low long-term compliance [7]. The surgical approach is still the most common OSAS treatment method and varieties of surgical techniques have been well-described in managing OSAS. Uvulopalatopharyngoplasty (UPPP) and radio frequency-induced thermotherapy (RFITT) of the soft palate have been widely used for the treatment of velopharyngeal obstruction in OSAS [8,9].

Randomized clinical trial of radiofrequency-induced thermotherapy combined with transilluminated powered phlebectomy versus high ligation and stripping for the treatment of lower limb varicose veins

ObjectiveThe objective of this study was to evaluate the efficacy and safety of radiofrequency-induced thermotherapy (RFiTT) combined with transilluminated powered phlebectomy (TIPP) in the treatment of lower limb varicose veins (VVs) in comparison with high ligation and stripping (HLS) combined with TIPP. MethodsThe patients with lower limb VVs were randomly assigned to RFiTT combined with TIPP or HLS combined with TIPP. The primary end point was total closure rate of the great saphenous vein at 12 months. Secondary end points included Venous Clinical Severity Score and 14-item Chronic Venous Insufficiency Questionnaire score changes at 12 months and perioperative complications. ResultsThe total closure rate of the great saphenous vein at 12 months was slightly lower in the RFiTT group (90.9% [90/99]) than in the HLS group (97.0% [98/101]) but not statistically significant (χ2 = 0.068; P = .08). Operation time, intraoperative blood loss, duration in hospital, duration in bed, and resumption of activities were statistically significantly better with RFiTT than with HLS. There were no significant differences between the groups in deep venous thrombosis, phlebitis, hematomas, pain, and infection. However, skin pigmentation and paresthesia were statistically significantly better with RFiTT than with HLS. At 12 months, both groups showed similar improvement from baseline in Venous Clinical Severity Score (1.28 ± 0.57 in the RFiTT group vs 1.33 ± 0.61 in the HLS group) and 14-item Chronic Venous Insufficiency Questionnaire score (67.32 ± 1.29 in the RFiTT group vs 67.45 ± 1.32 in the HLS group); however, neither group was superior to the other. ConclusionsRFiTT combined with TIPP is an effective treatment method for lower limb VVs and had a more satisfactory clinical outcome in surgical data, skin pigmentation, and paresthesia than HLS at the 12-month follow-up.

Bipolar Radiofrequency-Induced Thermotherapy (RFITT) for Varicose Veins: the Results of Pilot Study

Bipolar Radiofrequency-Induced Thermotherapy (RFITT) for Varicose Veins: the Results of Pilot Study

One-year results of the use of endovenous radiofrequency ablation utilising an optimised radiofrequency-induced thermotherapy protocol for the treatment of truncal superficial venous reflux

Background In previous invitro and ex vivo studies, we have shown increased thermal spread can be achieved with radiofrequency-induced thermotherapy when using a low power and slower, discontinuous pullback. We aimed to determine the clinical success rate of radiofrequency-induced thermotherapy using this optimised protocol for the treatment of superficial venous reflux in truncal veins. Methods Sixty-three patients were treated with radiofrequency-induced thermotherapy using the optimised protocol and were followed up after one year (mean 16.3 months). Thirty-five patients returned for audit, giving a response rate of 56%. Duplex ultrasonography was employed to check for truncal reflux and compared to initial scans. Results In the 35 patients studied, there were 48 legs, with 64 truncal veins treated by radiofrequency-induced thermotherapy (34 great saphenous, 15 small saphenous and 15 anterior accessory saphenous veins). One year post-treatment, complete closure of all previously refluxing truncal veins was demonstrated on ultrasound, giving a success rate of 100%. Conclusions Using a previously reported optimised, low power/slow pullback radiofrequency-induced thermotherapy protocol, we have shown it is possible to achieve a 100% ablation at one year. This compares favourably with results reported at one year post-procedure using the high power/fast pullback protocols that are currently recommended for this device.

Radiofrequency-induced thermotherapy (RFiTT) in a porcine liver model and ex vivo great saphenous vein

Aims: To investigate the thermal spread achieved in porcine liver when using an optimised radiofrequency ablation protocol and correlate findings with the effects seen in ex vivo great saphenous vein (GSV), in order to justify clinical use with the new treatment protocol.Material and methods: Porcine liver and GSV sections were treated with radiofrequency-induced thermotherapy (RFiTT) using the following settings: 20 W at 1 s/cm (linear endovenous energy density; LEED 20 J/cm), 18 W at 1 s/cm (LEED 18 J/cm), 18 W at 3 s/cm (LEED 54 J/cm), 6 W interrupted pull-back 6 s stationary every 0.5 cm (LEED 72 J/cm). Thermal spread in the liver was measured via digital imaging. GSV sections were sent to an independent laboratory for histological analysis. Previous work suggests a thermal spread of >0.65 mm in liver correlates with transmural thermoablation of a GSV.Results: Parameters giving a LEED of 72 J/cm produced the best results, with a clear transmural effect in the GSV and maximal thermal spread of 1.65 mm, without excessive thermal damage or carbonisation in the ablation tract.Conclusions: Our porcine liver model correlated well with histological findings and was representative of the thermoablative effects observed in the GSV wall treated with RFiTT. Clinical investigations are now being carried out to investigate the efficacy of this protocol in the clinical setting.

Innovations in nasal valve surgery.

This article reviews current practices in nasal valve repair and highlights recent innovations in the medical literature. A surgeon's choice regarding a proper nasal valve repair technique depends heavily on the patient's site of obstruction. While classical maneuvers to improve the internal and external nasal valves have been employed for several decades, increasing understanding of lateral wall insufficiency and its role in nasal valve compromise has led to improvement of proposed methods for correcting the nasal valve. Radiofrequency-induced thermotherapy, the upper lateral strut graft, stairstep graft, and nasal valve lift techniques are described in detail. These four techniques offer innovative means of dealing with the challenge of nasal valve collapse resulting in nasal obstruction. This review article provides an overview of the current practice in the field of nasal valve repair and summarizes recent technical advances in the field.

Operative Management of OSAS in a Complex Case of Proteus Syndrome.

Obstructive sleep apnea syndrome (OSAS) is a common disorder in childhood with high prevalence in syndromic subjects with craniofacial malformations. Proteus Syndrome (PS) is a rare hamartoneoplastic disorder associated with disproportionate and asymmetric overgrowth of body parts and hypertrophy or malformation of lymphatic tissues, such as palatine tonsils. We report a case of a 12-year-old boy diagnosed with Proteus Syndrome (PS) and suffering from OSAS due to asymmetric palatine tonsillar hypertrophy, treated with partial resection of left tonsil. To avoid the risk of a general anesthesia and remove only the obstructive portion of the palatine tonsil bipolar radiofrequency-induced thermotherapy (RFITT) under local anesthesia was performed. Recovery of the obstructive respiratory disease was obtained. To our knowledge, this is the first case reported in the literature of partial tonsillar resection performed in a patient with PS suffering from OSAS under local anesthesia.

An in vitro study to optimise treatment of varicose veins with radiofrequency-induced thermo therapy.

To develop a reproducible method of using radiofrequency-induced thermotherapy with adequate thermal spread to ablate the whole vein wall in a truncal vein but avoiding carbonisation, device sticking and high impedance "cut outs" reducing interruptions during endovenous treatments. Porcine liver was treated with radiofrequency-induced thermotherapy under glass to allow measurements, observation and video recording. Powers of 6-20 W were used at varying pullback speeds to achieve linear endovenous energy densities of 18-100 J/cm. Thermal spread, carbonisation of treated tissue and high-impedance cut outs were recorded. The currently recommended power settings of 18 and 20 W produced sub-optimal results. If pulled back at 3 s/cm to achieve linear endovenous energy densities around 60 J/cm, tissue carbonisation and high impedance cut outs occurred. When high powers and fast pullbacks of 1 s/cm were used, no carbonisation or cut outs occurred but thermal ablation of the liver model was below target due to reduced time for thermal conduction. Low powers (6-12 W) with slow pullbacks (6-12 s/cm) achieved target thermal ablation with minimal carbonisation and high impedance cut outs. Using low power (6 W) and a slow discontinuous pullback (6 s every 0.5 cm, in steps), we were able to achieve our target thermal ablation in the porcine liver model without carbonisation and high impedance cut outs. This suggests the currently recommended power levels could be reduced, reducing the need to remove the device to clean the electrodes during treatment while achieving target thermoablation of the treated tissue.

Influence of radiofrequency surgery on architecture of the palatine tonsils.

Radiofrequency surgery is a widely used modern technique for submucosal volume reduction of the tonsils. So far there is very limited information on morphologic changes in the human tonsils after radiofrequency surgery. We performed histopathological study of tonsillectomy specimens after previous bipolar radiofrequency induced thermotherapy (RFITT). A total of 83 patients underwent bipolar RFITT for hypertrophy of palatine tonsils. Tonsil volume reduction was measured by 3D ultrasonography. Five patients subsequently underwent tonsillectomy. Profound histopathological examination was performed to determine the effect of RFITT on tonsillar architecture. All tonsillectomy specimens showed the intact epithelium, intact germinal centers, normal vascularization, and no evidence of increased fibrosis. No microscopic morphological changes in tonsillectomy specimens after bipolar RFITT were observed. RFITT is an effective submucosal volume reduction procedure for treatment of hypertrophic palatine tonsils with no destructive effect on microscopic tonsillar architecture and hence most probably no functional adverse effect.

Endovenous radiofrequency ablation and combined foam sclerotherapy treatment of multiple refluxing perforator veins in a Klippel-Trenaunay syndrome patient

We describe an unusual pattern of venous abnormality and the use of endovenous radiofrequency ablation, using the TRans-Luminal Occlusion of Perforator technique to treat multiple refluxing perforators in a 29-year-old patient with Klippel-Trenaunay syndrome. Klippel-Trenaunay syndrome is a rare congenital anomaly characterised by a triad of features including unilateral limb overgrowth, venous varicosities and capillary malformations of the affected limb. Ultrasound findings demonstrated 22 incompetent perforator veins in the lateral aspect of the patients left leg, communicating with a complex network of large calibre varicosities causing unilateral leg oedema and pain. Staged radiofrequency ablation procedures using the Olympus Celon RFITT (radiofrequency-induced thermotherapy; please see Technical Note) device under local anaesthetic were performed. These procedures were followed with two sessions of foam sclerotherapy. This case report describes the efficacy of this treatment regime and this patient's significantly improved morbidity 18 months after initial treatment.

Long-term self-reported treatment effects and experience of radiofrequency-induced thermotherapy of the inferior turbinates performed under local anesthesia: a retrospective analysis

Nasal obstruction due to inferior turbinate hypertrophy is a common complaint. Radiofrequency-induced thermotherapy of the inferior turbinates (RFITT) under local anesthesia is now a widely used treatment, however reports of assessment of the long-term self-reported benefits and patient satisfaction of the treatment are scarce. This study focuses on the self-reported long-term effects of treatment and experience of RFITT. A questionnaire was sent to 441 patients who underwent RFITT in our clinic to treat symptoms of impaired nasal passage due to enlarged inferior turbinates. All patients had enlarged inferior turbinates on nasal examination. Patients were included if RFITT was done under local anaesthesia, was performed more than a year before the questionnaire was forwarded and on the indication-significant nasal obstruction because of enlarged inferior turbinates. Improvement of nasal breathing (by means of a Visual Analog Scale, VAS), changes in use of nasal spray (VAS), usage of pain medication, patient friendliness of the treatment, complaints reported after treatment, permanent effect of treatment during day and night time and willingness to recommend treatment to others were analyzed. No significant post-operative complications were observed. There was a significant reduction in use of nasal spray and the majority of patients interviewed reported long-term positive effects of RFITT during the daytime. This study shows that RFITT performed under local anesthesia is a valuable, minimally invasive, patient-friendly and well-tolerated treatment in patients with impaired nasal passage due to inferior turbinate hypertrophy.

Bipolar radiofrequency-induced thermotherapy of haemorrhoids: a new minimally invasive method for haemorrhoidal disease treatment. Early results of a pilot study.

IntroductionHaemorrhoidal disease is the most frequent benign anorectal disease. Conservative, minimally invasive and surgical methods are used in the treatment of haemorrhoidal disease. Radiofrequency thermoablation is a popular new technique in the treatment of varicose veins.AimAssessment of the use of the method in the treatment of haemorrhoidal disease using bipolar radiofrequency-induced thermotherapy (RFITT or so-called Celon method).Material and methodsWe used the CelonLab PRECISION (Celon AG medical instruments, Teltow, Germany) with the bipolar RFITT applicator Celon ProBREATH for the treatment of haemorrhoidal disease stages III and IV.ResultsIn the Department of Surgery at the Atlas Hospital in Zlin, Czech Republic, a total of 71 patients were treated from 9/2007 to 10/2010 with this new treatment approach. The success rate was 100%, local recurrence rate was 2.8%, and medium-term satisfaction of patients who underwent the procedure was 99.5%. Complications appeared in 4.26% of cases.ConclusionsThe new RFITTH technique for treatment of advanced stages of haemorrhoidal disease is a new treatment modality with good curative response, low level of complications, minimum pain and quick return of patients to their usual activities.

Bipolar radiofrequency-induced thermotherapy of great saphenous vein: Our initial experience

The incidence of varicose veins in lower limbs is increasing in the Indian subcontinent. With the advent of radiofrequency ablation (RFA), an effective minimally invasive technique is now available to treat varicose veins. RFA can be performed with either unipolar or bipolar probes. We present a simple technique for bipolar radiofrequency-induced thermotherapy of the great saphenous vein. This can be a safe and effective alternative to surgical procedures.

Selected surgical managements in snoring and obstructive sleep apnea patients

SummaryBackgroundThe diagnostic process and the surgical procedures in patients with snoring and obstructive sleep apnea syndrome (OSAS) are crucial. The aim of this study was to assess the efficacy of surgical treatment in snoring and OSAS patients.Material/MethodsA precise laryngological examination and screening polysomnography (Poly-Mesam) were performed in all patients with mild, moderate and severe OSAS before and 6 months after surgery. The patients completed questionnaires concerning their complaints. We included patients qualified to septoplasty, laser-assisted uvulopalatoplasty (LAUP), uvulopalatopharyngoplasty (UPPP) and radiofrequency-induced thermotherapy of the tongue base (RITT). Outcome evaluation of surgery was performed on the basis of data received from follow-up laryngological examinations, selected parameters obtained from the Poly-Mesam test and follow-up questionnaires.ResultsIn most cases we observed improvement, defined as decreasing some sleep parameters, such as a respiratory disturbance index (RDI), by more than 50%, decreasing the loudness of snoring, decreasing the number of hypopneas, and obtaining better blood saturation values. After UPPP we noticed changes in retropalatal space, soft palate dimensions and uvula-posterior pharyngeal wall distance. In the postoperative period we did not observe severe complications. In some cases we found short-lived palatal deficiency after UPPP. Patients after RITT experienced discomfort and throat pain lasting from 2 to 4 days. In 2 patients we observed swelling of the tongue base, which decreased after few days.ConclusionsSurgery in OSAS contributes to normalization of some sleep parameters. The majority of patients experienced improvement after surgery.

Radiofrequency induced thermotherapy (RFITT) of varicose veins compared to endovenous laser treatment (EVLT): a non-randomized prospective study concentrating on occlusion rates, side-effects and clinical outcome.

Radiofrequency obliteration (RFO) and endovenous laser treatment (EVLT) are established techniques in varicose therapy. A novel bipolar RFO technique - Radiofrequency Induced Thermotherapy (RFITT) - was introduced in 2007. Comparative studies of RFITT and EVLT with one year follow-up are missing. Comparison of RFITT with EVLT concentrating on occlusion, side-effects, and patients' satisfaction in a prospective non-randomized study. 133 patients with incompetent GSV or SSV were treated by RFITT (n=66) or EVLT (n=67). Follow-up at days 1, 7, and months 3, 12 included duplex, digital photoplethysmography (DPPG), assessment of VCSS and patients' satisfaction. Both groups were balanced concerning clinical parameters. Occlusion rates were in trend in favour of EVLT (96.9%) vs RFITT (88.9%), p=0.093, at 12 months follow-up. Functional outcome by DPPG (refilling time: 30.8 vs 31.9 sec.), and side-effects were comparable apart from pain in the first postoperative week, which was more frequent in the EVLT group (0 vs 16.4%, p=0.001). Change in VCSS from baseline was advantageous for EVLT (89.9% vs 79.3%, p=0.005). Major complications did not occur. Both techniques provided excellent satisfaction results. After one year RFITT is similarly as effective and safe as EVLT treatment of varicose insufficiency, but needs improvement in treatment parameters.

Safe use of bipolar radiofrequency induced thermotherapy (RFITT) for nasal surgery in patients with cochlear implants

Treatment of nasal turbinate hypertrophy with bipolar radiofrequency-induced thermotherapy (RFITT) is a common indication in patients affected by chronic vasomotor rhinitis. Nonetheless, there are no reports about the safety of such a surgical procedure in cochlear implant (CI) users, due to concerns that the spread of electrical current and heat could damage the CI inner component. We report two cases of CI recipients successfully and safely undergoing RFITT performed by means of the Olympus® Celon-ProBreath bipolar coagulation electrode.

Bipolar radiofrequency induced thermotherapy and 1064 nm Nd:Yag laser in endovenous occlusion of insufficient veins: short term follow up results

The aim of this study is to report our results in main stem vein closure using the bipolar radiofrequency induced thermotherapy (RFITT) system and the 1064 nm Nd:Yag laser. 44 incompetent main stem veins (37 great saphenous veins, one lesser saphenous vein, and 6 anterior accessory saphenous veins) in 29 patients were treated using RFITT. 53 incompetent main stem veins (45 great saphenous veins, 4 lesser saphenous veins, and 4 anterior accessory saphenous veins) in 43 patients were treated endovenously with 1064 nm Nd:Yag laser. All patients underwent postoperative duplex scanning within a month after procedure, as well as a short interview regarding postoperative discomfort. In main stem veins treated with RFITT, the success rate within the first month was 86,4 % (38 out of 44 veins). Complete failure rate was 13,6 % (6 out of 44 veins). In 53 main stem veins treated by 1064 nm Nd:Yag laser, the success rate was 100 %, consisting of 98,1 % complete success (52/53 veins), and 1,9 % partial success (1/53 veins). None of the patients treated with RFITT experienced postoperative adverse effects, whereas 13/43 (30,2 %) patients treated with laser had to use oral analgesics after the treatment, and 21/43 (48,8 %) patients reported transient skin changes, such as bruising or skin redness. RFITT system was fairly efficient in the short term for closure of main trunk veins, whereas longer term results are still scarce. Postoperative side effects of RFITT were minimal. 1,064 nm Nd:Yag laser, according to short term results, proved to be very effective for main stem vein closure. Postoperative side effects related to 1064 nm Nd:Yag endovenous laser treatment proved to be minor, transient, and acceptable.