Determining a minimal safe distance to prevent thermal injury to intrahepatic bile ducts in radiofrequency ablation of the liver: A study in dogs

Liu, Nianzhou; Gao, Jun; Liu, Yongkang; Li, Tingjun; Feng, Kai; Ma, Kui; Dong, Jiahong; Li, Xiaowu; Wang, Shuguang; Bie, Ping

doi:10.3109/02656736.2012.661915

Cited by 14 publications

(8 citation statements)

References 33 publications

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“…with ten years of clinical experience in the interpretation of liver and gastrointestinal pathology) reviewed the slides for the presence and depth of thermal injury. The depth of thermal injury was recorded as the deepest layer with thermal injury for the stomach, small bowel, and gallbladder [31–34]. Although an electrode was inserted 1cm away from the liver surface, gall bladder or biliary tract using USG guidance, distances were re-measured on the excised liver specimens using same manner, previously described for DEM measurement.…”

Section: Methodsmentioning

confidence: 99%

No-touch radiofrequency ablation using multiple electrodes: An in vivo comparison study of switching monopolar versus switching bipolar modes in porcine livers

et al. 2017

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ObjectiveTo evaluate the in vivo technical feasibility, efficiency, and safety of switching bipolar (SB) and switching monopolar (SM) radiofrequency ablation (RFA) as a no-touch ablation technique in the porcine liver.Materials and methodsThe animal care and use committee approved this animal study and 16 pigs were used in two independent experiments. In the first experiment, RFA was performed on 2-cm tumor mimickers in the liver using a no-touch technique in the SM mode (2 groups, SM1: 10 minutes, n = 10; SM2: 15 minutes, n = 10) and SB-mode (1 group, SB: 10 minutes, n = 10). The technical success with sufficient safety margins, creation of confluent necrosis, ablation size, and distance between the electrode and ablation zone margin (DEM), were compared between groups. In the second experiment, thermal injury to the adjacent anatomic organs was compared between SM-RFA (15 minutes, n = 13) and SB-RFA modes (10 minutes, n = 13).ResultsThe rates of the technical success and the creation of confluent necrosis were higher in the SB group than in the SM1 groups (100% vs. 60% and 90% vs. 40%, both p < 0.05). The ablation volume in the SM2 group was significantly larger than that in the SB group (59.2±18.7 cm3 vs. 39.8±9.7 cm3, p < 0.05), and the DEM in the SM2 group was also larger than that in the SB group (1.39±0.21 cm vs. 1.07±0.10 cm, p < 0.05). In the second experiment, the incidence of thermal injury to the adjacent organs and tissues in the SB group (23.1%, 3/13) was significantly lower than that in the SM group (69.2%, 8/13) (p = 0.021).ConclusionSB-RFA was more advantageous for a no-touch technique for liver tumors, showing the potential of a better safety profile than SM-RFA.

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Section: Methodsmentioning

confidence: 99%

No-touch radiofrequency ablation using multiple electrodes: An in vivo comparison study of switching monopolar versus switching bipolar modes in porcine livers

et al. 2017

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“…Thus, the operator should strike a balance between the potential risk of bile duct injury and the extent of the RF ablation zone. A minimum distance of 5 mm or more between the electrode tip and the bile ducts is usually required for preventing severe and irreversible bile duct injury ( 26 ). Ogawa et al ( 27 ) described that cooling the bile ducts with an endoscopic nasobiliary drainage tube was an effective way to prevent biliary complications during RF ablation.…”

Section: Technical Strategies For Safe Rf Ablationmentioning

confidence: 99%

Ultrasound-Guided Percutaneous Radiofrequency Ablation of Liver Tumors: How We Do It Safely and Completely

et al. 2015

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Ultrasound-guided percutaneous radiofrequency (RF) ablation has become one of the most promising local cancer therapies for both resectable and nonresectable hepatic tumors. Although RF ablation is a safe and effective technique for the treatment of liver tumors, the outcome of treatment can be closely related to the location and shape of the tumors. There may be difficulties with RF ablation of tumors that are adjacent to large vessels or extrahepatic heat-vulnerable organs and tumors in the caudate lobe, possibly resulting in major complications or treatment failure. Thus, a number of strategies have been developed to overcome these challenges, which include artificial ascites, needle track ablation, fusion imaging guidance, parallel targeting, bypass targeting, etc. Operators need to use the right strategy in the right situation to avoid the possibility of complications and incomplete thermal tissue destruction; with the right strategy, RF ablation can be performed successfully, even for hepatic tumors in high-risk locations. This article offers technical strategies that can be used to effectively perform RF ablation as well as to minimize possible complications related to the procedure with representative cases and schematic illustrations.

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“…36 However, in another study by Liu, the minimal experimentally determined safe distance between the RFA site and a bile duct was 5 mm. 37 These findings conflict with the traditional practice of leaving a short (5 mm) cystic duct remnant during LC for the purpose of preventing gallstone formation in the stump. 38 The stump length over 1 cm is considered excessive and is referred to as a “true postcholecystectomy syndrome” basis by some authors.…”

Section: Discussionmentioning

confidence: 97%

Thermal Processes in Bile Ducts During Laparoscopic Cholecystectomy with Monopolar Instruments. Experimental Study Using Real-Time Intraluminal and Surface Thermography

et al. 2020

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Introduction. A significant rate of complications during laparoscopic cholecystectomy (LC) occurs due to thermal injury caused by monopolar electrosurgery (MES) equipment. Most of them manifest weeks and months after surgery with the common bile duct (CBD) and large duodenal papilla strictures, some in the early postoperative period with bile leaks. Objective. To study thermal processes occurring in the lumen and on the surface of the bile ducts during monopolar coagulation in a porcine model of LC. Methods. The temperature of the bile ducts was measured using instrumentation consisted of biliary stent with temperature sensors, which was inserted in the porcine CBD, signal amplifier, and current sense transformer. Surface temperature was measured with a scientific grade thermal camera. Cholecystectomy was performed using a standard “critical view of safety” (CVS) approach with 5 mm monopolar laparoscopic instruments. Results. Application of MES caused significant tissue heating. Lateral thermal spread and the rate of tissue heating depended on the duration of energy application and the initial tissue temperature. In 5 out of 6 experiments, the intraluminal temperature rose up to the critical threshold, and the exposure time ranged from 54 to 560 seconds. A sensor positioned at the papilla site was heated in all the experiments but still below the cell damage inducing threshold. The analysis of thermographic charts revealed the presence of the “current channeling” effect and the pedicle effect. Conclusion. There is a possibility of a direct and delayed thermal injury to the bile ducts during LC.

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Determining a minimal safe distance to prevent thermal injury to intrahepatic bile ducts in radiofrequency ablation of the liver: A study in dogs

Abstract: A minimum safe distance of 5.0 mm between the RFA electrode and intrahepatic bile ducts was effective in preventing serious complications secondary to bile duct injury in a canine model.

Cited by 14 publications

References 33 publications

No-touch radiofrequency ablation using multiple electrodes: An in vivo comparison study of switching monopolar versus switching bipolar modes in porcine livers

No-touch radiofrequency ablation using multiple electrodes: An in vivo comparison study of switching monopolar versus switching bipolar modes in porcine livers

Ultrasound-Guided Percutaneous Radiofrequency Ablation of Liver Tumors: How We Do It Safely and Completely

Thermal Processes in Bile Ducts During Laparoscopic Cholecystectomy with Monopolar Instruments. Experimental Study Using Real-Time Intraluminal and Surface Thermography

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