Radiofrequency ablation is a process in which radiofrequency waves are passed through the electrode to disturb the surrounding tissue ions. When the electrode temperature increases, the tumor tissue in different organs may be destroyed. In 1998, Solbiati et al published the first paper about RFA ablation in thyroid diseases. Recently, RFA has also been proven to relieve cosmetic problems and compressive symptoms caused by benign thyroid nodules. Let’s take a look at the history of RFA.
The History of Thyroid RFA
The Radiofrequency Ablation technique has been around since 1931. Martin Kirschner, a German surgeon, first utilized radiofrequency ablation around 90 years ago while experimenting with treating trigeminal neuralgia. It was around 30 years later before the first radiofrequency ablation device came on the market from Aronow and Cosman.
In 2006, radiofrequency ablation of thyroid nodules was introduced and had been reported to be effective and safe for treating recurrent thyroid cancer and benign thyroid nodules. Later, thyroid-dedicated devices for RFA, indications, and basic techniques were introduced by the KSThR, Korean Society of Thyroid Radiology, in 2012. Since 2012, RFA for thyroid nodules has been adopted globally, with subsequent advances made in techniques and devices such as thinner and shorter electrodes, virtual needle tracking systems, bipolar electrodes, and unidirectional electrodes.
Furthermore, two basic techniques, the moving-shot technique, and the trans-isthmic approach have been validated in multiple studies. In addition, advanced techniques like hydro-dissection and vascular ablation have also been developed.
RFA Equipment and Procedure Advancement
Since the thyroid gland is small, electrodes have been modified to be internally cooled, thinner, and shorter than traditional electrodes used in other organs. To reduce the pain during thyroid RFA, perithyroidal lidocaine injection has been used. The two techniques, Marginal venous ablation, and artery-first ablation have been recently developed and can be applied to hypervascular nodules with prominent feeding arteries. Furthermore, it’s essential to understand US-based neck anatomy to enhance the efficacy of RFA procedures. Since the neck is narrow and contains multiple critical structures, it’s complicated to treat a tumor entirely. Therefore, hydro-dissection is an effective technique to separate tumors from surrounding critical structures.
During an RFA procedure, venous drainage maximizes the heat-sink effect and interfaces with the ablation of the target nodule’s margin. To resolve this, an advanced marginal venous ablation technique is used in which the marginal vein is first punctured by the electrode tip and then ablated. In various publications, the marginal venous ablation technique helps prevent recurrence by entire tumor ablation.
Wrapping Up A History of RFA
As more RFA procedures are conducted and clinically proven positive results increase, the techniques and devices for radiofrequency ablation of thyroid nodules will continue to evolve. Understanding the most effective RFA technique and choosing the optimal treatment strategy is essential for patient safety and to optimize treatment efficacy. Our manufacturer, RF Medical Co., Ltd., is a medical company whose prime aim is to popularize radiofrequency ablation treatments.
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