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THERMAL ABLATION

TATO SYSTEM

Laura Sarti Product Specialist

Definition

Thermal Ablation (TA) is the use of extreme hiperthermic temperatures to destroy diseased tissues.

T.A. is performed in Interventional Radiology as an alternative to the surgical treatment of tumors in:

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Different TA technologies

• Radiofrequency

• Microwaves

• Laser

• Cryoablation

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RF Current Flow

• RF Currents that goes through the tissue from the tip of the applicator to the ground pad.

Side effect: skin burning. 4 4

MW Energy

Microwaves radiate only near the tip of the applicator.

An applied MW field causes water molecules to rotate bilions of time per second , which leads to

heat generation.

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Comparison between RF and MW thermal ablation

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• Heat sink effect

• Ground pad required

• Difficult to control the increase

of ablation

• Less influenced by veins

• Ground pad is not required

• Predictable and controllable ablation

• Compatible with pacemaker

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TATO :

Multiprobe microwave

thermal ablation System

Rev. 09 del 27.10.2016

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Main features of the system

1 • No cooling system

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• Ergonomic and easily transportable

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• Multi-probes with detachable cable

1. No cooling system

The NIC (Not Internally Cooled) coax needles have a high energy efficiency that allows operating with less MW power for treatment up to 15 minutes.

Cooling system not needed

Less complexity

Higher reliability

Greater safety

Better applicator handling

Reducing procedure dead time

Easy control of the procedure

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Switch Unit Roll Stand

2.Ergonomic and easily transportable

Main Unit- Microwave generator

Articulated Arm extendable up to 1,5 m

Tato cart version Tato travel version

Switch Unit Roll Stand

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Main unit Handle

On/off button

Touchscreen 7,1 inch

Yellow Led: lighting indicates that MWs are ON

Red Led: when lighting up, it indicates a fault

2,45 GHz

120 W total power

IEC standards

compliant

USB port

Extendable arm and switch cover

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Extendable up to 1.5 m

Sterile cover for arm

• Total power 120 W • 1 to 4 power outputs

TATO1 vs TATO2

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FEATURES TATO1 TATO2

TOTAL POWER 100W 120W

DATA LOGGING

DATA

DOWNLOAD

TRACK ABLATION

PROTOCOL

REFLECTED

POWER

MONITORING

SELECTION

NEEDLE GAUGE

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11 G

14 G

17 G

18 G

Multi-Gauge

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DIAMETER

G mm

3 mm

2,1 mm

1,5 mm

1,2 mm

11 G

14 G

17 G

18 G

The thinnest applicator currently

available in the world market

Version with infusion tip

Holes 0,3 mm Ø

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• 14 G and 17 G version • Applicator with 4 micro-holes in the tip for fluid infusion • A syringe can be used to inject fluids during the treatment

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• Simple radiating monopole

• High efficiency

• Lightweight

(~35g w/o cable, 50g w/cable)

• Detachable feeding cable:

advantage under CT scan

Main structural features

Massa - Patient with HCC

Usability of TATO under CT-scan

Extendable arm

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Echogenic needle

Video of needle insertion

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• All steel tips are tested with an applied force of 5kg.

• No fragile ceramic parts are used

• All probes are Teflon covered, non-sticky.

• Available in different lengths from 10 up to 50 cm.

• Centimeter marked cannula

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Main structural features

How to insert the needle

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E

Lesion

Ablation

E

Insert the tip of the needle into the lesion and use length E parameter (indicated in the chart) as reference.

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Control of increasing ablation volume : By employing lower MW power, the procedure’ s safety is increased, thus eliminating a lot of bubble gas and ensuring a better control under ultrasound.

Gauge Max power W

11 60

14 40

17 30

18 15

Main functional features

In order to operate safely, antennas must be used respecting the assigned power limits:

Increasing ablation

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TATO 2 HMI

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TATO2 HMI Home Screen

Setting

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Language

Date and time

LOG Download

Services

Output mating cycles :

1

4

3

2

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TATO2 Home Screen

Possibility to insert Patient ID, Physician ID and note

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Needle choice

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Therapy Setting

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Therapy summary

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Therapy running

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REFLECTED POWER COEFFICIENT OK : NEEDLE IS WORKING WELL AIR : NEEDLE IS IN THE AIR MISMATCH : NON-OPTIMAL FUNCTIONING OF NEEDLE NOT CONNECTED : NEDDLE IS NOT CONNECTED

Therapy ended - Summary

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TRACK

ABLATION

Track Ablation

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Video for Track ablation

• 14 G, 60 W, 25 sec

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Ex – vivo and in – vivo charts of Tato System

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CHARTS TATO2

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ABLATION ZONE EXAMPLES* – 1 APPLICATOR Ex – vivo Bovine Liver

11 G 60 W

Duration (min) 10:00 15:00

L (cm) 6,0 7,0

D( cm) 4,3 5,0

E (cm) 1,3 1,5

14 G 40 W

Duration (min) 5:00 10:00 15:00

L (cm) 5,0 5,4 6,2

D( cm) 2,6 4,0 4,5

E (cm) 0,9 1,0 1,1

17 G 30 W

Duration (min) 5:00 10:00 15:00

L (cm) 4,6 5,0 5,6

D( cm) 2,5 3,4 3,8

E (cm) 0,8 1,0 1,2

18 G 10 W 15 W

Duration (min) 5:00 10:00 5:00 10:00

L (cm) 2,0 2,6 2,3 3,3

D( cm) 1,4 1,7 1,5 2,3

E (cm) 0,4 0,6 0,6 0,6

CHARTS TATO2

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CHARTS TATO2

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CHARTS TATO2

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E.g. HCC or liver metastasis

• Examples of MW applications in different liver tumors with same values of watt and time.

• HCC : «oven effect» due to the tissue’s consistency that is rich in water and to the encapsulated tumor’s morphology . The result is a bigger ablation.

• Metastasis: no «oven effect» because of the tissue has less water content and is not encapsulated. The result is a smaller ablation.

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Frequently used parameters In vivo most frequently used values of power (W) and time (min) • D = diameter

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Diameter

of tumor

0,5 <D<1 1<D<2 2<D<2,8 2,8 <D<4 D>4

Gauge

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60 W

Open

surgery

1 needle

10 min

2 needles

15 min

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40 W

1 needle

10 min

1 needle

15 min

2 needles

15 min

3 needles

15min

4 needles

10 min

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30 W

1 needle

10 min

2 needles

15 min

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15W

1 needle

10 min

Microwave ablation system Cross- reference

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Padova – TATO use in laparoscopy

• Lesion: 7 cm

• 2 x 14 G, 35 W, 15 min

• And Repositioning 1 x 14G, 35 W, 4.5 min

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Treatment on HCC (percutaneous)

Dimension of the tumor 5 X 3 cm Used 2 x 17G

Padova – Open surgery

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9 tumors in total RESECTION AND ABLATION Data of the first 4 ablations: 18 mm, 35W, 10min 19 mm, 35W, 2.3min and 40W, 1.30min 20 mm, 40W, 6min 18 mm, 40W, 6.2min

Osteoid osteoma

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Osteoid osteoma in vertebra 18G, 10W, 6min

Aarau - Patient with kidney tumor

Multi-probe case Tumor size: 2.4 x 2.2 cm (+2 cm margin) Number of antennas: 4 x 14G Power: 100W total Time: 15min

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