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  • Multiprobe RF ablation: A Feasibility Study Fred T. Lee Jr., MD Dieter Haemmerich, MS Andrew S. Wright, MD David M. Mahvi, MD John G. Webster, PhD University
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Multiprobe RF ablation: A Feasibility Study Fred T. Lee Jr., MD Dieter Haemmerich, MS Andrew S. Wright, MD David M. Mahvi, MD John G. Webster, PhD ersity of Wisconsin Depts. Of Radiology, Bioenginee Surgery

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Page 1: Multiprobe RF ablation: A Feasibility Study Fred T. Lee Jr., MD Dieter Haemmerich, MS Andrew S. Wright, MD David M. Mahvi, MD John G. Webster, PhD University

Multiprobe RF ablation: A Feasibility Study

Fred T. Lee Jr., MD

Dieter Haemmerich, MS

Andrew S. Wright, MD

David M. Mahvi, MD

John G. Webster, PhD

University of Wisconsin Depts. Of Radiology, Bioengineering, Surgery

Page 2: Multiprobe RF ablation: A Feasibility Study Fred T. Lee Jr., MD Dieter Haemmerich, MS Andrew S. Wright, MD David M. Mahvi, MD John G. Webster, PhD University

Why multiprobe RF?

Page 3: Multiprobe RF ablation: A Feasibility Study Fred T. Lee Jr., MD Dieter Haemmerich, MS Andrew S. Wright, MD David M. Mahvi, MD John G. Webster, PhD University

Why multiprobe RF?

Page 4: Multiprobe RF ablation: A Feasibility Study Fred T. Lee Jr., MD Dieter Haemmerich, MS Andrew S. Wright, MD David M. Mahvi, MD John G. Webster, PhD University

Why multiprobe RF?

Page 5: Multiprobe RF ablation: A Feasibility Study Fred T. Lee Jr., MD Dieter Haemmerich, MS Andrew S. Wright, MD David M. Mahvi, MD John G. Webster, PhD University

Why multiprobe RF?

• Simultaneous ablations

– Increase lesion number

– Multiple probes in large tumor

• Decrease ablation time

• Improve temperature distribution in lesion (make ablation more effective)

• Control lesion (bigger not always better)

Page 6: Multiprobe RF ablation: A Feasibility Study Fred T. Lee Jr., MD Dieter Haemmerich, MS Andrew S. Wright, MD David M. Mahvi, MD John G. Webster, PhD University

Current RF systems

• Multiple prongs run at same voltage

RITA

RTC

Radionics

Page 7: Multiprobe RF ablation: A Feasibility Study Fred T. Lee Jr., MD Dieter Haemmerich, MS Andrew S. Wright, MD David M. Mahvi, MD John G. Webster, PhD University

Faraday Effect

Page 8: Multiprobe RF ablation: A Feasibility Study Fred T. Lee Jr., MD Dieter Haemmerich, MS Andrew S. Wright, MD David M. Mahvi, MD John G. Webster, PhD University

Faraday Effect

Electrodes at same voltage

Page 9: Multiprobe RF ablation: A Feasibility Study Fred T. Lee Jr., MD Dieter Haemmerich, MS Andrew S. Wright, MD David M. Mahvi, MD John G. Webster, PhD University

Faraday Effect

Probes at different voltage=bipolar Current flows between probes

Page 10: Multiprobe RF ablation: A Feasibility Study Fred T. Lee Jr., MD Dieter Haemmerich, MS Andrew S. Wright, MD David M. Mahvi, MD John G. Webster, PhD University

Faraday Effect

Electrically independent probes

Page 11: Multiprobe RF ablation: A Feasibility Study Fred T. Lee Jr., MD Dieter Haemmerich, MS Andrew S. Wright, MD David M. Mahvi, MD John G. Webster, PhD University

How independent probes created

• Rapid switching between probes

• Temperature in tissue changes much slower than switching

• Temperature/impedance feedback algorithm

Page 12: Multiprobe RF ablation: A Feasibility Study Fred T. Lee Jr., MD Dieter Haemmerich, MS Andrew S. Wright, MD David M. Mahvi, MD John G. Webster, PhD University

How independent probes created

Page 13: Multiprobe RF ablation: A Feasibility Study Fred T. Lee Jr., MD Dieter Haemmerich, MS Andrew S. Wright, MD David M. Mahvi, MD John G. Webster, PhD University

Prototype dual probe unit

Page 14: Multiprobe RF ablation: A Feasibility Study Fred T. Lee Jr., MD Dieter Haemmerich, MS Andrew S. Wright, MD David M. Mahvi, MD John G. Webster, PhD University

Prototype dual probe unit

Page 15: Multiprobe RF ablation: A Feasibility Study Fred T. Lee Jr., MD Dieter Haemmerich, MS Andrew S. Wright, MD David M. Mahvi, MD John G. Webster, PhD University

Ex vivo results: Dual probes in pig liver at same temperature

Page 16: Multiprobe RF ablation: A Feasibility Study Fred T. Lee Jr., MD Dieter Haemmerich, MS Andrew S. Wright, MD David M. Mahvi, MD John G. Webster, PhD University

In vivo results

• Domestic pigs (n=3, mean wt=35 kg)• 13 RF lesions

– 3 single control lesions– 10 dual (5 pairs created simultaneously)

RITA Model 150 generator (150 W), Starburst electrode deployed to 3.0 cm. 10 minute ablation, 100° C.

Page 17: Multiprobe RF ablation: A Feasibility Study Fred T. Lee Jr., MD Dieter Haemmerich, MS Andrew S. Wright, MD David M. Mahvi, MD John G. Webster, PhD University

In vivo results

vs

Single Simultaneous dual RF

Note: same scale

Page 18: Multiprobe RF ablation: A Feasibility Study Fred T. Lee Jr., MD Dieter Haemmerich, MS Andrew S. Wright, MD David M. Mahvi, MD John G. Webster, PhD University

In vivo results

• Time to temperature (100°C)

single: 2.7 minutes (162 seconds)

dual: 3.4 minutes (204 seconds)

Page 19: Multiprobe RF ablation: A Feasibility Study Fred T. Lee Jr., MD Dieter Haemmerich, MS Andrew S. Wright, MD David M. Mahvi, MD John G. Webster, PhD University

In vivo results:volume of necrosis

• Single: 10.7 cc

• Dual (each individual lesion): 17.3cc

Therefore, 34.6 cc ablation obtained in approximately same time as 10.7 cc ablation

Page 20: Multiprobe RF ablation: A Feasibility Study Fred T. Lee Jr., MD Dieter Haemmerich, MS Andrew S. Wright, MD David M. Mahvi, MD John G. Webster, PhD University

In vivo results:max diameter

• Single: 3.3 cm

• Dual (each individual lesion): 3.8 cm

Page 21: Multiprobe RF ablation: A Feasibility Study Fred T. Lee Jr., MD Dieter Haemmerich, MS Andrew S. Wright, MD David M. Mahvi, MD John G. Webster, PhD University

Conclusions

• Feasible to create multiple simultaneous burns with a single generator

• No lesion size penalty

• Slight increase in time to temperature

Page 22: Multiprobe RF ablation: A Feasibility Study Fred T. Lee Jr., MD Dieter Haemmerich, MS Andrew S. Wright, MD David M. Mahvi, MD John G. Webster, PhD University

What’s next?

• Increase # of probes (?4)

• Will require increased generator power

• Many technical factors involved with rapid switching (mechanical electrical)

• Cluster probes in close proximity to increase lesion size, temperature


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