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Editorial
. 2022 Feb;11(1):132-135.
doi: 10.21037/hbsn-21-512.

No touch radiofrequency ablation for hepatocellular carcinoma: a conceptual approach rather than an iron law

Olivier Seror  1   2   3
Affiliations
Editorial

No touch radiofrequency ablation for hepatocellular carcinoma: a conceptual approach rather than an iron law

Olivier Seror. Hepatobiliary Surg Nutr. 2022 Feb.
No abstract available

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Conflict of interest statement

Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at https://hbsn.amegroups.com/article/view/10.21037/hbsn-21-512/coif). The author has no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Bull’s eye diagrams of no-touch radiofrequency ablation of tumor using 3 straight electrodes in multi-monopolar versus multi-bipolar mode. In multi-monopolar mode each electrode induces in perpendicular axis a circular centrifugal radiating electromagnetic typically enables an ablation of 2 cm maximal diameter around the electrode. The ablation of the entire tumor and the margin requires the overlaps of each ablation zones that depends on interelectrode distance (with the current monopolar devices available in clinical practice, 1.7 cm is the maximal interelectrode distance recommended to achieve consistently continuous ablation between two electrodes). In multi-bipolar mode each pair of electrodes induces in perpendicular axis elliptical centripetal radiating electromagnetic typically enables an ablation of 2.5 cm × 1.5 cm between the electrodes. To ensure the coverage of the entire tumor and the margin requires the overlaps of each elliptical ablation zones induced by each pair of electrodes that the long axis is strongly linked to interelectrode distance (with the current bipolar devices available in clinical practice, 3 cm is the maximal interelectrode distance recommended to achieve consistently continuous ablation between two electrodes). Thus, this diagram shows clearly that using 3 separate straight electrodes for the no-touch ablation of a same 1.7 cm diameter tumor, comparing with the multi-monopolar mode the multi-bipolar mode allows easier coverage of the tumor including a more consistent thick of ablative margin. Moreover, the multi-bipolar mode that allows longer interelectrode distance insertions accommodates better than multi-monopolar mode a possible mistargeting due to unperfect coregistration of real-time ultrasonography with referral volume imaging set (CT or MRI) when insertions of electrodes are performed under fusion imaging guidance. On this diagram a 6 mm mismatch between the two imaging modalities leads to incomplete ablation with multi-monopolar mode while with multi-bipolar mode the entire tumor is still covered.
See this image and copyright information in PMC

Comment on

References

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