Electrical-thermal performance of a cooled RF applicator for hepatic ablation with additional distant infusion of hypertonic saline: in vivo study and preliminary computer modeling.

PURPOSE: The Cool-tip electrode is one of the most widely employed applicators in radiofrequency (RF) hepatic ablation. Previous research demonstrated that it is possible to enlarge coagulation volume when the single cooled electrode is associated with distant infusion of saline (hybrid applicator). The aim of this study was to compare the electrical-thermal behaviour of the Cool-tip electrode with that of the hybrid applicator. MATERIALS AND METHODS: Forty-two RF ablations were performed on a total of 10 pigs: 22 with the Cool-tip electrode and 20 with the hybrid applicator (low infused saline volumetric flow rate of 6 mL/h at 2 mm distance). We compared both electrical performance (delivered power and number of roll-offs, i.e. sudden rises in impedance that interrupt the power delivery) and coagulation zone characteristics. In addition, we built a one-dimensional model to provide a basic physical explanation of the difference in performance between the different applicators. RESULTS: The experimental results showed that the number of roll-offs with the Cool-tip electrode was higher (24.3 ± 3.1 versus 6.7 ± 7.0). The hybrid applicator created larger coagulation volumes (19.7 ± 9.5 cm(3) versus 9.5 ± 5.8 cm(3)) with larger transverse diameters (2.5 ± 0.6 versus 1.9 ± 0.5 cm). The one-dimensional model confirmed the delay in the incidence of the first roll-off, but not the heterogeneity of the hybrid applicator's electrical performance in the experiments. CONCLUSIONS: The hybrid applicator produces fewer roll-off episodes than the Cool-tip electrode and creates larger coagulation volumes with larger transverse diameters.

Distant infusion of saline may enlarge coagulation volume during radiofrequency ablation of liver tissue using cool-tip electrodes without impairing predictability.

OBJECTIVE: Our aim was to evaluate the capability of a Cool-tip electrode to create larger coagulation volumes combined with a low-flow (0.1 mL/min) perfusion of hypertonic saline at a distance of 2 mm (hybrid applicator) without reducing either predictability or sphericity of the coagulation zone. MATERIALS AND METHODS: A total of 48 radiofrequency ablations were performed on a total of 12 adult pigs: 24 with the Cool-tip (group 1) and 24 with the hybrid applicator (group 2). Volumes and diameters were assessed both macroscopically and with imaging techniques (ultrasound and MRI). Digital reconstruction techniques were also used. Reproducibility of the coagulations was assessed by means of the coefficient of variation. RESULTS: The macroscopic assessment showed a significantly larger coagulation zone in group 2 than in group 1, both with (19.40 ± 11.38 cm(3) vs 9.16 ± 5.62 cm(3); p < 0.001) and without (19.54 ± 11.39 cm(3) vs 9.21 ± 5.74 cm(3); p < 0.001) digital reconstruction. Differences were also significant in the MRI assessment. The minimum transverse diameter was also significantly (p < 0.01) larger in group 2 than group 1: 2.46 ± 0.61 versus 1.86 ± 0.55 cm for macroscopic assessment, 2.33 ± 0.96 versus 1.69 ± 0.53 cm for ultrasound, and 2.41 ± 0.58 versus 1.8 ± 0.52 cm for MRI. The coefficient of variation was similar in both groups. CONCLUSION: The results suggest that low-flow perfusion of hypertonic saline at 2 mm from a Cool-tip electrode could increase coagulation zone volume without reducing predictability.