thermal ablation tato system - amt medi · padova – tato use in laparoscopy •lesion: 7 cm •2...
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THERMAL ABLATION
TATO SYSTEM
Laura Sarti Product Specialist
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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
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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
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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
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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
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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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14
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
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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
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Massa - Patient with HCC
Usability of TATO under CT-scan
Extendable arm
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Echogenic needle
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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
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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:
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Increasing ablation
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TATO 2 HMI
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TATO2 HMI Home Screen
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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
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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
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Therapy ended - Summary
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TRACK
ABLATION
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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
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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
11
60 W
Open
surgery
1 needle
10 min
2 needles
15 min
14
40 W
1 needle
10 min
1 needle
15 min
2 needles
15 min
3 needles
15min
4 needles
10 min
17
30 W
1 needle
10 min
2 needles
15 min
18
15W
1 needle
10 min
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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
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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
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Osteoid osteoma
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Osteoid osteoma in vertebra 18G, 10W, 6min
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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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