The modern use of radiofrequency energy in surgery, endoscopy and interventional radiology

Zusammenfassung

GRUNDLAGEN: Der therapeutische Einsatz der Radiofrequenzenergie (RF) in der Medizin nimmt zu. Diese Arbeit beschreibt 4 neue RF-Instrumente für Chirurgie, Endoskopie und interventioneller Radiologie. METHODIK: Die 4 Instrumente sind: 1) Endoblate zur endoskopischen RF-Therapie beim Rektumkarzinom; 2) Hexablate, ein bipolares RF-Instrument zur Behandlung des Hepatoms; 3) VesCoag, ein bipolarer RF-Katheter zum interventionell-radiologischem Verschluss von Tumorgefäßen der Leber und 4) EndoHPB, ein endoskopischer bipolarer RF-Katheter zur endobiliären Ablation, derzeit im Schweiemodel getestet. ERGEBNISSE: Endoblate, Hexablate and VesCoag zeigten im klinischen Einsatz keine technischen Probleme und unerwünschte Nebenwirkungen. Alle wurden bipolar verwendet bis auf VesCoag, welches nur monopolar Effizienz bei der Gefäßversiegelung zeigte. Bei EndoHPB zeigte sich im Schweinemodell, dass 5–10 Watt für 2 Minuten die ideale Einstellung war. Eine klinische Studie untersucht derzeit den Einsatz bei malignem Verschlussikterus. SCHLUSSFOLGERUNGEN: Die RF-Instrumente stellen eine faszinierende Entwicklung dar, welche vielversprechende therapeutische Methoden in Endoskopie, Chirurgie und interventioneller Radiologie erwarten lassen.

Summary

BACKGROUND: The potential applications of radiofrequency (RF) energy in medicine are an expanding field. This paper describes the development and early results of the application of four novel radiofrequency devices in surgery, endoscopy and interventional radiology. METHODS: The four devices that were designed and have been assessed were 1) Endoblate: a bipolar RF catheter for endoscopic use which was assessed in patients with rectal tumors, 2) Hexablate: a bipolar RF ablation/aspiration device which was used to treat liver cancers, 3) VesCoag: a bipolar RF catheter for endovascular ablation which was used by interventional radiologists to seal the blood vessels of tumors within the liver and 4) EndoHPB: an endoscopic bipolar RF catheter for endobiliary ablation which so far has been assessed in a porcine model. RESULTS: In the pilot clinical studies on Endoblate, Hexablate and VesCoag, all the devices could be used in the clinical situation for which they had been designed. There were no technical problems and no serious adverse events associated with their use. All were used in bipolar mode apart from VesCoag, where it was found that a monopolar current was required for effective vessel sealing. For EndoHPB in the porcine model, it was determined that the ideal power setting was 5–10 watts for 2 min. A clinical trial is to be undertaken to determine whether this power setting is applicable for when EndoHPB is used in the management of malignant obstructive jaundice. CONCLUSIONS: It is an exciting time in the development of new RF instruments, and as they become more sophisticated their clinical applications will expand. These early data from the animal and pilot clinical studies are promising and larger studies with longer term follow-up needs to be undertaken to establish their true clinical worth.