Patients with HCC underwent PRFA at Saga Central Hospital between April 2004 and October 2020. Among them, we excluded those undergoing their second or later PRFA; therefore, we only enrolled consecutive patients who received PRFA as the first treatment. Ultrasound-guided PRFA was performed one week after CL. Specifically, we used the Cool-Tip RF system (Covidien, Boulder, CO, USA) that utilizes internally cooled electrodes for ablation through an internal cooling device, thus reducing the impedance. We also used needle electrodes of various lengths depending on the tumor size. Additionally, we heated the HCC tissue to 70−80 °C until the impedance markedly increased, which created frictional heat, causing the death of tumor cells. Since tumor ablation depends on the impedance of the tissue and is proportionate to the distance from electrodes, an appropriate needle was selected.
Cool tip rf system
Manufactured by Medtronic
Sourced in United States
The Cool-Tip RF system is a medical device designed for radiofrequency (RF) ablation procedures. It provides controlled delivery of RF energy to targeted tissue areas.
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Lab products found in correlation
7 protocols using cool tip rf system
1
Ultrasound-Guided Radiofrequency Ablation for HCC
2
Ablation of Small Renal Tumors Using CT-Guided RFA
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Our ablation technique was previously described in details [21 (link),22 (link)]. In summary, we perform RFA procedures with the patient under general anesthesia using computed tomography (CT) imaging guidance (SOMATOM Definition AS, Siemens Medical Systems, Erlangen, Germany). After ablation planning, the probes are positioned, and we perform the biopsy (if not previously performed) before starting the ablation. Adjunctive techniques (i.e., hydrodissection and pyeloperfusion) are used when needed. When hydrodissection is required, we use dextrose 5% mixed with a nonionic contrast at a ratio of 60:1. We perform RFA for small renal tumors (3.5 cm or smaller) [17 (link)] using the Cool-tip RF system (Covidien, Mansfield, MA, USA). The generator is modulated gradually to increase the power up to 150–180 W in order to achieve an ablative temperature of at least 60 °C. Two ablative cycles (6 min each) are applied. Immediately following ablation, we perform multi-phase contrast-enhanced computed tomography (CT) to assess the zone of ablation and identify any immediate complications. Additional cycles of ablation are performed at the discretion of the interventional radiologist if the ablation appears to be incomplete upon immediate post-procedure contrast-enhanced CT. Follow-up cross-sectional imaging is performed at regular intervals for up to 2 years and then every year.
3
Radiofrequency Ablation of Hepatocellular Carcinoma
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Our RFA procedures were percutaneously performed by 1 of 3 radiologists who had 13, 11, and 9 years of clinical experience, respectively. RFA procedures and data assessment were based on Detailed methods of RFA are described in previous studies.[9 (link),10 (link)] All patients were treated when they were under IV conscious analgesic sedation. Commercially available internally cooled electrode systems with generators (Cool-tip RF System, Covidien, Mansfield, MA, USA; VIVA RFA System, STARmed, Goyang, Korea) were performed for all patients with HCCs in our cohort. Various electrodes including the single electrode with a 2 cm active tip, or with an adjustable active tip (Proteus RF Electrode, STARmed), or a cluster-electrode (Cool-tip, Covidien; Octopus, STARmed) were used according to tumor size and equipment availability. The energy deposition algorithm used was consistent with the introduced protocols. Our strategy was to include an ablative margin of at least 0.5 cm of normal hepatic parenchyma surrounding the tumor, as well as the entire tumor itself, with the exception of the perivascular portions and subcapsular. Our strategy of RFA was finished when the hyperechoic ablation range was large enough to cover the entire tumor and the expected ablative margin.
4
Ultrasound-Guided Radiofrequency Ablation of Thyroid Nodules
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US-guided RFA was performed by one of two radiologists with 14 and 18 years of experience. All ablations were performed using radiofrequency (RF) generators (Cool-Tip RF system, Covidien; SSP-2000, Taewoong Medical; and M-1004, RF Medical) and an 18-gauge internally cooled adjustable RF electrode with a variable-sized active tip and a total length of 8 or 10 cm (Well-point RF electrodes or Proteus RF electrodes, STARmed). Local anesthesia was induced with a 1% lidocaine injection into the puncture site and perithyroidal area [26 (link)]. The fluid was aspirated before RFA of the thyroid nodules with cystic components. The RF power used was approximately 30–50 W. RF ablation was terminated when the nodule exhibited hyperechoic changes.
5
Multimodal HCC Treatment Strategies
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PH or RF was planned at least 6 weeks after SIRT at the discretion of the multidisciplinary treatment group. This period has been decided for radioprotection safety reasons. As the patients included were initially candidate for surgical treatment, the time before surgery was kept relatively short to limit the risk of dropout in case of non-response and tumour progression.
For patients in whom SIRT was not feasible, surgery was performed soon after the simulation procedure. PH was preferentially proposed for peripheral HCC and when tumour size was >30 mm. RF was preferentially proposed for tumours 30 mm, that were centrally located and at distance from major vessels, and when surgery would require a major hepatectomy. PH was performed via laparoscopic or open approach according to technical considerations and surgeon's choice. All resections were performed under intraoperative ultrasound (IOUS) guidance with the aim of achieving a tumour-free margin. Major resection was defined as the resection of 3 liver segments. RF was performed preferentially via a laparoscopic approach or via an open approach when required for access reasons, under IOUS guidance using Radiotherapeutics (Boston Scientific) or Cool-Tip™ RF System (Covidien) devices. Completeness of RF treatment was verified with IOUS by the creation of a hyperchogenic zone covering the entire initial tumour volume.
For patients in whom SIRT was not feasible, surgery was performed soon after the simulation procedure. PH was preferentially proposed for peripheral HCC and when tumour size was >30 mm. RF was preferentially proposed for tumours 30 mm, that were centrally located and at distance from major vessels, and when surgery would require a major hepatectomy. PH was performed via laparoscopic or open approach according to technical considerations and surgeon's choice. All resections were performed under intraoperative ultrasound (IOUS) guidance with the aim of achieving a tumour-free margin. Major resection was defined as the resection of 3 liver segments. RF was performed preferentially via a laparoscopic approach or via an open approach when required for access reasons, under IOUS guidance using Radiotherapeutics (Boston Scientific) or Cool-Tip™ RF System (Covidien) devices. Completeness of RF treatment was verified with IOUS by the creation of a hyperchogenic zone covering the entire initial tumour volume.
6
Percutaneous RFA for Tumor Ablation
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Percutaneous RFA using the Cool‐tip RF system (Medtronic, Minneapolis, MN, USA) was performed under ultrasonographic guidance in all patients. Artificial pleural effusion or artificial ascites was produced using saline as needed. The impedance control mode was used with a 17‐gauge, cooled‐tip electrode with a 2‐ or 3‐cm exposed tip. After an electrode was inserted into the tumor, ablation was started at 40 W for the 2‐cm exposed tip or 60 W for the 3‐cm exposed tip. Electric power was increased at a rate of 10 W/min. When a rapid increase in impedance occurred, output was stopped automatically, and ablation was restarted after a short time at an output 10 W lower. Duration of a single ablation was 6 min for the 2‐cm electrode and 12 min for the 3‐cm electrode. Temperature of the needle tip was measured after radiofrequency (RF) exposure, with additional ablation performed if the temperature was below 65°C. The electrode track was not ablated in any patient to prevent seeding and hemorrhage.
7
CT-Guided Radiofrequency Ablation for Intrahepatic Tumors
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Radiofrequency ablation for intrahepatic tumors was carried out under CT guidance in our institution. The exact locations and depths of the lesions were determined on the acquired CT slices. If the lesion could not be clearly located on non-enhanced CT scan, the needle was placed on nearby anatomical landmarks to correlate with pre-ablation CT or MRI for precise localization of the lesion. In some cases, a bolus of contrast medium was administered intravenously to determine the exact location of the lesion. All RFA procedures were performed with a Cool-tip RF system (Medtronic, Covidien). Artificial ascites would be created for protection of thermal injuries if the lesion was within 1 cm of the gastrointestinal tract. Immediately after the procedure, all patients underwent dynamic contrast-enhanced CT with both arterial and venous phases to evaluate the ablative zone and procedure-related complications.
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