Comparison of tissue pressure and ablation time between the LeVeen and cool-tip needle methods

Makoto Nakamuta, Motoyuki Kohjima, Shusuke Morizono, Tsuyoshi Yoshimoto, Yuzuru Miyagi, Hironori Sakai, Munechika Enjoji, Kazuhiro Kotoh, Makoto Nakamuta, Motoyuki Kohjima, Shusuke Morizono, Tsuyoshi Yoshimoto, Yuzuru Miyagi, Hironori Sakai, Munechika Enjoji, Kazuhiro Kotoh

Abstract

Background: Radio frequency ablation (RFA) has been accepted clinically as a useful local treatment for hepatocellular carcinoma (HCC). However, intrahepatic recurrence after RFA has been reported which might be attributable to increase in intra-tumor pressure during RFA. To reduce the pressure and ablation time, we developed a novel method of RFA, a multi-step method in which a LeVeen needle, an expansion-type electrode, is incrementally and stepwise expanded. We compared the maximal pressure during ablation and the total ablation time among the multi-step method, single-step method (a standard single-step full expansion with a LeVeen needle), and the method with a cool-tip electrode. Finally, we performed a preliminary comparison of the ablation times for these methods in HCC cases.

Results: A block of pig liver sealed in a rigid plastic case was used as a model of an HCC tumor with a capsule. The multi-step method with the LeVeen electrode resulted in the lowest pressure as compared with the single-step or cool-tip methods. There was no significant difference in the ablation time between the multi-step and cool-tip ablation methods, although the single-step methods had longer ablation times than the other ablation procedures. In HCC cases, the multi-step method had a significantly shorter ablation time than the single-step or cool-tip methods.

Conclusion: We demonstrated that the multi-step method was useful to reduce the ablation time and to suppress the increase in pressure. The multi-step method using a LeVeen needle may be a clinically applicable procedure for RFA.

Figures

Figure 1
Figure 1
The maximal pressure (A) and total ablation time (B) on the porcine liver model, compared for the various tested methods. The multi-step method with a LeVeen needle resulted in a significantly lower pressure than the cool-tip procedure or the single-step method, and a total ablation time equal to that of the cool-tip procedure. All measurements were performed four times, and the results are expressed as mean ± SD. Statistical comparisons for the maximal pressure and the total ablation time were made using ANOVA and Scheffe's test. ap < 0.05 vs. cool-tip; bp < 0.05 vs. single-step.

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