Determining the critical effective temperature and heat dispersal pattern in monopolar radiofrequency ablation using temperature-time integration

Tseng, How; Lin, Sey‐En; Chang, Yen‐Liang; Chen, Ming Hsu; Hung, Shih‐Han

doi:10.3892/etm.2015.2956

Cited by 9 publications

(9 citation statements)

References 24 publications

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“…Three articles reported about thermal damage to muscular or fat tissue. Thermal damage was reported after short‐term exposure (< 2 min) to temperatures above 55 °C or long‐term exposure (> 20 min) to temperatures above 43 °C [12, 22, 33]. The inflicted tissue damage in fat was, at any given temperature, increased twofold compared to muscle tissue [12].…”

Section: Resultsmentioning

confidence: 99%

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Electrocautery in arthroscopic surgery: intra-articular fluid temperatures above 43 °C cause potential tissue damage

Derriks

Hilgersom

Middelkoop

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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Purpose The use of electrocautery during arthroscopy may heat intra‐articular saline and subsequently damage intra‐ and extra‐articular tissue. Newer electrocautery devices have the ability to measure the outflow fluid temperature and switch off before reaching a certain threshold; however, the scientific evidence establishing these temperature thresholds’ potential for inadvertent damage is lacking. The aim of this study was to analyse current available literature on temperature thresholds for tissue damage after exposure to heated fluid and provide a recommendation for the maximum temperature of intra‐articular fluid to prevent tissue damage. Methods In February 2018, a systematic literature review was performed using the MEDLINE/PubMed and Embase databases. Inclusion was limited to studies investigating temperature thresholds for thermal damage to at least one of the tissues of interest: skin, bone, cartilage, soft tissues, and nerves. Studies not reporting specific temperature thresholds for thermal damage were excluded. Results Twenty articles were selected for the final evaluation and data extraction. Varying temperature thresholds, based on the lowest reported temperature causing tissue damage, were found for the different tissues of interest: 44 °C for dermal tissues, between 47 and 50 °C for bony tissues, 50 °C for cartilage, between 43 and 55 °C for soft tissues, and 43 °C for nerves. Conclusion Based on the current literature, a temperature threshold for intra‐articular fluid of 43 °C during an arthroscopic procedure is recommended to prevent tissue damage. Higher temperatures may cause damage to surrounding intra‐ and extra‐articular tissues. The threshold for irreversible damage is likely to be higher. In clinical practise, one should be aware of possible heating of intra‐articular fluid when using electrocautery and related risk of tissue damage. Level of evidence III.

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Section: Resultsmentioning

confidence: 99%

“…There will be no structural damage to the soft tissues after exposure of short duration (< 2 min) to temperatures below 55 °C. For longer exposure times (> 20 min), this threshold will decrease to around 43 °C, with an exponential increase in tissue damage with increasing temperatures [12, 33].…”

Section: Discussionmentioning

confidence: 99%

Electrocautery in arthroscopic surgery: intra-articular fluid temperatures above 43 °C cause potential tissue damage

Derriks

Hilgersom

Middelkoop

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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“…First, Cosman primarily studied bovine liver (due to its more easily visualized color changes compared to muscle, which visually changes color at higher temperatures reducing the visibility of thermal ablation patterns) and egg white. Importantly, bovine liver coagulates at lower temperatures (~45-50°C 18 ) than mammalian muscle tissue (~55-65°C 25 ). While chickens are not mammals, the thermal injury threshold is similar at roughly 65°C.…”

Section: Conc Lusionmentioning

confidence: 99%

Bipolar radiofrequency ablation lesion areas and confluence: An ex vivo study and technical report

Wondra,

Gulhar,

Brestle

et al. 2023

Pain Practice

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IntroductionRadiofrequency ablation (RFA) has been used for nearly 100 years, treating an array of medical conditions including chronic pain. Radiofrequency (RF) energy depolarizes and repolarizes tissues adjacent to a probe producing heat and causing direct thermal injury. When positioned adjacent to neural structures, it leads to neural tissue injury and cell death interrupting pain signaling with the ultimate goal of providing lasting pain relief. Today, RFA is commonly used to treat cervical, thoracic, and lumbar zygapophyseal joints, sacroiliac joint, and more recently large peripheral joint‐mediated pain. There are several applications of RFA systems, including bipolar, conventional thermal, cooled, protruding, and pulsed. As yet, no study has determined the best technical practice for bipolar RFA.ObjectiveThis ex vivo study examines RFA lesion midpoint (LMP) area and lesion confluence comparing three different commonly used gauge (g) probes (18‐g, 20‐g, and 22‐g) with 10‐mm active tips at various interprobe distances (IPD) to guide best technical practices for its clinical application.MethodsBipolar RFA lesions were generated in preservative‐free chicken breast specimens using three different gauge probes (18‐g, 20‐g, and 22‐g) with 10‐mm active tips at various IPD (6, 8, 10, 12, 14, 16, and 18 mm). RF was applied for 105 s (15‐s ramp time) at 80°C for each lesion at both room and human physiological temperature. The specimen tissues were dissected through the lesion to obtain a length, width, and depth, which were used to calculate the LMP area (mm2). The LMP areas of each thermal ablation were investigated using visualization and descriptive analysis. The Kruskal–Wallis test was performed to compare LMP areas between the two temperature groups and the three different gauge probe subgroups at the various IPDs.ResultsOf the 36 RF lesions (14: 18‐g, 12: 20‐g, and 10: 22‐g) performed, 24 demonstrated lesion confluence. The average time to reach 80°C was 16–17 s; therefore, the average time of RF‐energy delivery (at goal temperature) was 88–89 s despite varying needle size or IPD. Comparing the 25 and 37°C groups, 18‐g probes produced mean LMP areas of 73.7 and 79.2 mm2, respectively; 20‐g probes produced mean LMP areas of 66 and 66.8 mm2, respectively; 22‐g probes produced mean LMP areas of 56.6 and 59.7 mm2, respectively. There was no statistical evidence to state a difference regarding LMP area between temperature groups; however, the 18‐g probes produced consistently larger LMP areas in the 37°C compared to 25°C specimen groups at each IPD. Lesion confluence was lost for 18‐g, 20‐g, and 22‐g probes at IPD of 14, 12, and 10 mm, respectively, in both 25 and 37°C groups. LMP area was similar between 6 and 8 mm IPD in all of the three‐gauge groups; however, there was a significant drop in LMP area from 8 mm IPD to 10 mm and greater. The 18‐g, 20‐g, and 22‐g probes all demonstrated a sharp decline in LMP area when increasing the IPD from 8 to 10 mm.ConclusionThis ex vivo technical study evaluated bipolar RFA LMP areas and lesion confluence, and determined the recommended IPD of 18‐g, 20‐g, and 22‐g probes to be less than 12, 10, and 8 mm, respectively, for best clinical practice. Placing bipolar probes at an IPD greater than 14, 12, and 10 mm, respectively, risks the loss of lesion confluence and failure to produce a clinically significant treatment response due to lack of nerve capture. In clinical practice, the use of injectate may produce larger lesions than demonstrated in this study. Additionally, in vivo factors may impact ablation zone size and ablation patterns. As there are a paucity of studies comparing various RFA applications and conventional RFA needles are least expensive, it is possible that bipolar conventional RFA is more cost‐effective than other techniques.

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“…Temperatures of these points, i.e. the critical temperature threshold T crit , is 55 °C according to the experimental results of Tseng et al (2016). By substituting the properties of each point into (5) or (6), we obtain some linear equations of C 11 , C 12 and C 2 , the values of which will be solved by the weighted least squares method as a pre-processing step.…”

Section: Weighted Least Squares Fittingmentioning

confidence: 99%

Fast calculation of 3D radiofrequency ablation zone based on a closed-form solution of heat conduction equation fitted by ex vivo measurements

Chen¹,

Zhang²,

Kong³

et al. 2021

Phys. Med. Biol.

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Fast calculation or simulation of the ablation zone induced by radiofrequency ablation (RFA) has a critical role in hepatic RFA planning and therapy. However, it remains challenging to approximate the ablation zone in real time, especially when more than one probe is involved in one ablation session. This paper presents a novel computational technique to calculate the 3D ablation zone of one probe RFA and two-probe switching RFA. The main idea is to get an approximate solution of the temperature distribution from a simplified Pennes bioheat equation, and further fit the solution to the coagulation measurements on ex vivo porcine liver. With a closed-form solution of temperature distribution, the calculation of the ablation zone is as simple as the commonly used ellipsoidal model, but it allows a more realistic prediction of combined ablation zones with different inter-probe spacing. The new approximation technique could potentially replace the original ellipsoidal model in the intervention planning step.

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Determining the critical effective temperature and heat dispersal pattern in monopolar radiofrequency ablation using temperature-time integration

Cited by 9 publications

References 24 publications

Electrocautery in arthroscopic surgery: intra-articular fluid temperatures above 43 °C cause potential tissue damage

Electrocautery in arthroscopic surgery: intra-articular fluid temperatures above 43 °C cause potential tissue damage

Bipolar radiofrequency ablation lesion areas and confluence: An ex vivo study and technical report

Fast calculation of 3D radiofrequency ablation zone based on a closed-form solution of heat conduction equation fitted by ex vivo measurements

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