Hepatic radiofrequency ablation using multiple probes: ex vivo and in vivo comparative studies of monopolar versus multipolar modes.
OBJECTIVE
We wanted to compare the efficiency of multipolar radiofrequency ablation (RFA) using three perfused-cooled electrodes with multiple overlapping and simultaneous monopolar techniques for creating an ablation zone in ex vivo bovine livers and in in vivo porcine livers.


METHODS
In the ex vivo experiments, we used a 200 W generator (Valleylab, CC-3 model) and three perfused-cooled electrodes or internally cooled electrodes to create 30 coagulation zones by performing consecutive monopolar RFA (group A, n = 10), simultaneous monopolar RFA (group B, n = 10) or multipolar RFA (group C, n = 10) in explanted bovine livers. In the consecutive mode, three ablation spheres were created by sequentially applying 150 watts radiofrequency (RF) energy to the internally cooled electrodes for 12 minutes each for a total of 36 minutes. In the simultaneous monopolar and multipolar modes, RF energy was concurrently applied to the three perfused-cooled electrodes for 20 minutes at 150 watt with instillation of 6% hypertonic saline at 2 mL/min. During RFA, we measured the temperatures of the treated area at its center. The changes in impedance, the current and liver temperature during RFA, as well as the dimensions of the thermal ablation zones, were compared among the three groups. In the in vivo experiments, three coagulations were created by performing multipolar RFA in a pig via laparotomy with using same parameter as the ex vivo study.


RESULTS
In the ex vivo experiments, the impedance was gradually decreased during the RFA in groups B and C, but in group A, the impedance was increased during RFA and this induced activation by the pulsed RF technique. In groups A, B and C, the mean final-temperature values were 80+/-10 degrees C, 69+/-18 degrees C and 79+/-12 degrees C, respectively (p < 0.05). The multipolar mode created a larger volume of ablation than did the other modes: 37.6+/-4.0 cm3 (group A); 44.9+/-12.7 cm3 (group B); and 78.9+/-6.9 cm3 (group C) (p < 0.05). In the in vivo experiment, the pig well tolerated the RFA procedure and no major complications occurred during the 4 days of the follow-up period. The mean volume of coagulations produced by multipolar RFA in the pig liver was 60.5+/-17.9 cm3.


CONCLUSIONS
For the multiple probe RFA, the multipolar mode with hypertonic saline instillation was more efficient in generating larger areas of thermal ablation than either the consecutive or simultaneous monopolar modes.
Lee
Jeong Min
JM
Department of Radiology, and Institute of Radiation Medicine, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.
Han
Joon Koo
JK
Lee
Jae Young
JY
Kim
Se Hyung
SH
Choi
Jin Young
JY
Lee
Min Woo
MW
Choi
Seung Hong
SH
Eo
Hong
H
Choi
Byung Ihn
BI
D000818:Animals; D001831:Body Temperature; D017115:Catheter Ablation / Q000295:instrumentation* / Q000379:methods; D002417:Cattle; D004566:Electrodes; D004867:Equipment Design; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology / Q000502:physiology / Q000601:surgery*; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery; D009336:Necrosis; D013552:Swine; D014057:Tomography, X-Ray Computed