Transperineal Microwave Thermoablation in Patients with Obstructive Benign Prostatic Hyperplasia: A Phase I Clinical Study with a New Mini-Choked Microwave Applicator

Bartoletti, Riccardo; Cai, Tommaso; Tinacci, Galliano; Longo, I.; Ricci, Andrea; Massaro, Maria Pia; Tosoratti, N.; Zini, Enzo; Pinzi, Novello

doi:10.1089/end.2007.0329

Cited by 11 publications

(9 citation statements)

References 24 publications

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“…minimising the size (gauge) of the applicator, maximising the available power for tissue irradiation, and full control over the coagulation size and shape, thus avoiding back‐heating phenomena (the ‘comet’ effect) due to uncontrolled microwave power reflection, and yielding spheroid lesions close to the applicator tip. We developed a new microwave probe for interstitial thermoablation, the Amica‐Probe v3 (Hospital Services SpA, Aprilia, Italy) which is a development of a previously described applicator (Amica‐Probe v2 [9];) which, while retaining the essential benefit of its predecessor (small gauge, 17 G; internal water cooling to avoid shaft overheating; and a patented built‐in device, the ‘mini‐choke’, to entrap reflected microwaves, capable of producing spheroidal lesions), provides enhanced mechanical and electrical properties. The first aim was to evaluate tolerability and the ability to produce complete and homogeneous tissue ablation without tissue ‘skipping’ in the treated area.…”

Section: Introductionmentioning

confidence: 99%

In vivo microwave‐induced porcine kidney thermoablation: results and perspectives from a pilot study of a new probe

Bartoletti

Cai

Tosoratti³

et al. 2010

BJU International

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thermoablations overall. The kidneys were then surgically removed, and necrotic lesions measured and evaluated microscopically. The sphericity index (SI) was also calculated to evaluate lesion reproducibility. Areas of renal tissue that were missed were then microscopically evaluated by NADH in vivo staining. RESULTSIn all, 32 thermoablations were applied; the mean ( SD ) lesion diameter ranged from 1.2 (0.3) to 4.2 (0.1) cm and changed in relation to both power and time of exposure. The 50-W power particularly induced necrotic renal lesions ranging from 1.9 (0.2) to 4.2 (0.1) cm as a function of the time of exposure and the optimal SI (1.04). Pathological evaluation showed no skipped areas in the context of the lesion, or healthy kidney tissue damage close to necrotic lesions. CONCLUSIONSThermoablation with the Amica probe is safe and showed excellent in vivo effects in this porcine model. Increasing the exposure time at 50 W power could be a useful percutaneous minimally invasive treatment for small solid masses ( < 4.2 cm), avoiding the risk of missing tumour areas or kidney parenchymal damage from microwave treatment.

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Section: Introductionmentioning

confidence: 99%

In vivo microwave‐induced porcine kidney thermoablation: results and perspectives from a pilot study of a new probe

Bartoletti

Cai

Tosoratti³

et al. 2010

BJU International

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“…The mean age-adjusted Charlson comorbidity index was 4.8 (range, 3-7). The mean RENAL score was 9.4 (range, [8][9][10][11][12]. Table I shows the clinical and laboratory characteristics of enrolled patients.…”

Section: Resultsmentioning

confidence: 99%

“…The system used for MWTA was HS AMICA, with the Amica-probe V4 applicator (Hospital Services SpA, Aprilia, Italy), which is a technical development of a previously described applicator (Amica-probe V3) (12). Amica-probe V4 includes a coaxial antenna and an integrated hydraulic circuit to cool the coaxial feeding line.…”

Section: Introductionmentioning

confidence: 99%

Microwave-induced thermoablation with Amica-probe is a safe and reproducible method to treat solid renal masses: Results from a phase I study

et al. 2012

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Abstract. Microwave thermal ablation (MWTA) could be considered in the future for treating small solid renal masses. The aim of the present study was to determine both the tolerability of the new Amica-probe applicator-induced MWTA used in vivo on patients with solid renal masses and the effects of heating on renal tumors and normal renal parenchyma. Fourteen patients with renal masses eligible for open radical nephrectomy were enrolled in this phase I study. All patients underwent MWTA of renal masses during the open surgery procedure before clamping of renal vascular pedicle. The effects of MWTA on patients' coagulation and tumor/renal vasculature were investigated. The histological effects of MWTA on the tumor and intralesional vital tumor cell skipping were also evaluated. The MWTA-induced lesion diameters were measured to calculate both the overall ablation volume and the lesion sphericity index (SI). The Clavien-Dindo classification was used. In all patients the RENAL score was 9.4 (8-12) and the Charlson comorbidity index was 4.8 (3-7). MWTA-induced lesion size was 44.14 mm (±22.59). Mean SI was 1.08 (±0.2). No significant differences among coagulation clinical parameters were found. No local bleeding after MWTA treatment was reported. According to the ClavienDindo classification, there were two grade II perioperative complications due to the tumor extent but not related with the MWTA treatment. No residual vital tumor cells inside the MWTA-induced lesions were found. Telephone interview at 27.4 (±4.2) months mean follow-up did not find any long-term adverse events due to previous MWTA treatment. AmicaProbe applicator-induced MWTA is a safe and reproducible method to treat solid renal masses. IntroductionPrevalence of small solid renal masses in adult population recently increased probably due to the large number of people that daily undergo preventive diagnostic investigations such as ultrasonography and computed tomography (CT) scan for unrelated symptoms, resulting in incidental tumor detection (1). Patients' comorbidities, such as cardiovascular or respiratory diseases, could represent limiting factors for planning adequate subsequent surgical approaches although conservative laparoscopy surgery is now considered the gold standard treatment, particularly for tumors <3-4 cm (2). Minimally invasive procedures, such as cryoablation (CryA) and radiofrequency ablation (RFA), have been recently proposed by different authors as alternative methods of treatment to conservative surgery with satisfactory results in terms of perioperative complications such as hemorrhage episodes or metabolic problems related to prolonged period of general anaesthesia (3). Some doubts remain on the efficacy of these methods on tumor complete eradication due to the high prevalence of tumor local recurrences due to persistent vital tumor cells in the context of the ablated tissue (tumor skipping) (4). Both CryA and RFA are based on the application of physical means (cold and heat respectively) at the centre of the lesion to induce...

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“…However, the only clinically relevant quantity is the power irradiated into the target tissues, which is significantly lower than the nominal power, and generally differs from system to system even for equal nominal power levels. Early MWA technologies suffered from the poor predictability of the radiated field pattern and from uncontrolled back-heating effects (often referred to in literature as "comet effect" [53,54] ) due to the reflected waves (i.e., MW radiations not absorbed by the target tissues and back-propagating along the probe shaft outer walls) generated by the inevitable impedance mismatches between the antenna and the tissues. On the one hand, this caused unwanted, deep cauterisation of tissues along the probe shaft, increasing the risk of complications; on the other hand, it reduced the antenna efficiency, dispersing the MW field longitudinally rather than focussing it on the probe distal end.…”

Section: A B C Dmentioning

confidence: 99%

Microwave ablation of hepatocellular carcinoma

Poggi¹

2015

WJH

108

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thermal ablation techniques provide a valid nonsurgical treatment alternative, thanks to their minimal invasiveness, excellent tolerability and safety profile, proven efficacy in local disease control, virtually unlimited repeatability and cost-effectiveness. Different energy sources are currently employed in clinics as physical agents for percutaneous or intra-surgical thermal ablation of HCC nodules. Among them, radiofrequency (RF) currents are the most used, while microwave ablations (MWA) are becoming increasingly popular. Starting from the 90s', RF ablation (RFA) rapidly became the standard of care in ablation, especially in the treatment of small HCC nodules; however, RFA exhibits substantial performance limitations in the treatment of large lesions and/or tumors located near major heat sinks. MWA, first introduced in the Far Eastern clinical practice in the 80s', showing promising results but also severe limitations in the controllability of the emitted field and in the high amount of power employed for the ablation of large tumors, resulting in a poor coagulative performance and a relatively high complication rate, nowadays shows better results both in terms of treatment controllability and of overall coagulative performance, thanks to the improvement of technology. In this review we provide an extensive and detailed overview of the key physical and technical aspects of MWA and of the currently available systems, and we want to discuss the most relevant published data on MWA treatments of HCC nodules in regard to clinical results and to the type and rate of complications, both in absolute terms and in comparison with RFA. AbstractAlthough surgical resection is still the optimal treatment option for early-stage hepatocellular carcinoma (HCC) in patients with well compensated cirrhosis, TOPIC HIGHLIGHT Microwave ablation of hepatocellular carcinoma Advances in Hepatocellular Carcinomaalready available about a direct comparison between radiofrequency ablation and microwave ablation; in this review we provide an extensive and detailed overview on the technical and engineering aspects of microwave devices, and we critically expose the most relevant clinical data about the experience in microwave ablation, also by making a comparison with radiofrequency ablation.

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Transperineal Microwave Thermoablation in Patients with Obstructive Benign Prostatic Hyperplasia: A Phase I Clinical Study with a New Mini-Choked Microwave Applicator

Cited by 11 publications

References 24 publications

In vivo microwave‐induced porcine kidney thermoablation: results and perspectives from a pilot study of a new probe

In vivo microwave‐induced porcine kidney thermoablation: results and perspectives from a pilot study of a new probe

Microwave-induced thermoablation with Amica-probe is a safe and reproducible method to treat solid renal masses: Results from a phase I study

Microwave ablation of hepatocellular carcinoma

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