title: Infrared thermography and thermocouple mapping of radiofrequency renal ablation to assess treatment adequacy and ablation margins.
abstract: OBJECTIVE
  The primary disadvantage of renal tumor RF ablation is the inability to monitor the intraoperative propagation of the RF lesion with real-time imaging. We sought to assess whether adequately lethal temperatures are obtained at the margins of the intended ablation zone using laparoscopic thermography to monitor radiofrequency (RF) lesions in real time, thermocouple measurements, and histopathologic evaluation.
  
  
  METHODS
  Renal RF lesions were created under direct laparoscopic vision in the upper (1 cm diameter) and lower (2 cm) poles of the right kidney in 5 female pigs. The RF lesions were produced with the RITA generator and probe, set at 105 degrees C for 5-minute ablations. During RF treatment, a laparoscopic infrared (IR) camera measured the surface parenchymal temperatures, as did multiple thermocouples. The pigs were then either immediately killed (n = 3) or allowed to live for 2 weeks (n = 2). The kidneys were removed to correlate the temperature measurements with histologic analysis of the ablated lesion.
  
  
  RESULTS
  Using a threshold temperature of greater than 70 degrees C for visual "temperature" color change, the IR camera identified the region of pathologic necrosis of the renal parenchyma during RF ablation. Thermocouple measurements demonstrated that the temperatures at the intended ablation radius reached 77.5 degrees C at the renal surface and 83.7 degrees C centrally, and temperatures 5 mm beyond the set radius reached 52.6 degrees C at the surface and 47.7 degrees C centrally. The average diameter of the gross lesion on the surface of the kidney measured 17.1 mm and 22.4 mm for 1-cm and 2-cm ablations, respectively. These surface measurements correlated with an average diameter of 16.1 mm and 15.9 mm (1-cm and 2-cm ablations, respectively) as measured with the IR camera. All cells within these ablation zones were nonviable by nicotinamide adenine dinucleotide diaphorase analysis. The average depth of the lesions measured 19 mm (1-cm ablation) and 25 mm (2-cm ablation) on gross histologic examination.
  
  
  CONCLUSIONS
  The laparoscopic IR camera is able to monitor the surface renal temperatures during RF treatment. Thermocouple measurements during RF ablation confirmed the thermographic findings and demonstrated that lethal temperatures at the margin of the intended treatment zone are routinely obtained and that a rapid decline in temperature occurs beyond the predicted ablation margin.
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9110, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Ogan
authors.forename: William W
authors.initials: WW
authors.lastname: Roberts
authors.forename: David M
authors.initials: DM
authors.lastname: Wilhelm
authors.forename: Leonard
authors.initials: L
authors.lastname: Bonnell
authors.forename: Dennis
authors.initials: D
authors.lastname: Leiner
authors.forename: Guy
authors.initials: G
authors.lastname: Lindberg
authors.forename: Louis R
authors.initials: LR
authors.lastname: Kavoussi
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Cadeddu
mesh_terms: D000818:Animals; D001831:Body Temperature; D004564:Electrocoagulation / Q000295:instrumentation / Q000379:methods*; D005260:Female; D007259:Infrared Rays; D007668:Kidney / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D000078702:Radiofrequency Therapy; D013552:Swine; D013817:Thermography / Q000295:instrumentation / Q000379:methods*; D013821:Thermometers