Basics of radiofrequency tissue ablation

Abstract

Surgical advances generally follow either a scientific discovery or a technological breakthrough, for example magnetic resonance imaging or joint replacement. Over the past few years, the advent of new energy sources, such as radiofrequency, has had an increasing impact on surgical practice, especially in the field of liver tumours. Liver resection presently offers the only opportunity for cure in patients with liver cancer, either primary or secondary. Unfortunately, most hepatic cancers are unsuitable for curative resection at the time of diagnosis. Limitations for surgical resection can broadly be classified as either: 1) tumour-related, i.e. lesions that are extremely large, awkwardly sited, multiple, involving major vascular structures, associated with extrahepatic disease or 2) patient-related, i.e. intercurrent medical conditions, old age and poor liver function, especially in those with underlying cirrhosis. Therefore, there is a clear need, for the development of a simple and effective technique to control unresectable tumours within the liver and, preferably, one that avoids a lengthy hos pital stay in patients with limited duration of survival. In the past few years, minimal access has beco me available for the destruction of hepatic carcinomas by methods such as ethanol injection and thermoablation, with cryoprobes, laser or radiofrequency. Radiofrequency ablation (RFA) has now been widely accepted as an effective modality for treating liver turnouts that are unsuitable for resection. It is based on the conversion of radiofrequency waves into heat, leading to coagulative necrosis, and it can be delivered either percutaneously or at open operation. © 2006 Springer-Verlag/Wien.