Hepatic Radiofrequency Ablation Using Multiple Probes: Ex Vivo and In Vivo Comparative Studies of Monopolar versus Multipolar Modes

Objective: We wanted to compare the efficiency of multipolar radiofrequency ablation (RFA) using three perfused-cooled electrodes with multiple overlapping and simultaneous monopolar techniques for creating an ablation zone in ex vivo bovine livers and in vivo porcine livers. Materials and Methods: In the ex vivo experiments, we used a 200W generator (Valleylab, CC-3 model) and three perfused-cooled electrodes or internally cooled electrodes to create 30 coagulation zones by performing consecutive monopolar RFA (group A, n=10), simultaneous monopolar RFA (group B, n=10) or multipolar RFA (group C, n=10) in explanted bovine livers. In the consecutive mode, three ablation spheres were created by sequentially applying 150 watts radiofrequency (RF) energy to the internally cooled electrodes for 12 minutes each for a total of 36 minutes. In the simultaneous monopolar and multipolar modes, RF energy was concurrently applied to the three perfused-cooled electrodes for 20 minutes at 150 watt with instillation of 6% hypertonic saline at 2mL/min. During RFA, we measured the temperatures of the treated area at its center. The changes in impedance, the current and liver temperature during RFA, as well as the dimensions of the thermal ablation zones, were compared among the three groups. In the in vivo experiments, three coagulations were created by performing multipolar RFA in a pig via laparotomy with using same parameter as the ex vivo study. Results: In the ex vivo experiments, the impedance was gradually decreased during the RFA in groups Band C, but in group A, the impedance was increased during RFA and this induced activation by the pulsed RF technique. In groups A, Band C, the mean final-temperature values were $80{\pm}10^{\circ}C$, $69{\pm}18^{\circ}C$ and $79{\pm}12^{\circ}C$, respectively (p<0.05). The multipolar mode created a larger volume of ablation than did the other modes: $37.6{\pm}4.0cm^3$ (group A); $44.9{\pm}12.7cm^3$ (group B); and $78.9{\pm}6.9cm^3$ (group C) (p<0.05). In the in vivo experiment, the pig well tolerated the RFA procedure and no major complications occurred during the 4 days of the follow-up period. The mean volume of coagulations produced by multipolar RFA in the pig liver was $60.5{\pm}17.9cm^3$. Conclusion: For the multiple probe RFA, the multipolar mode with hypertonic saline instillation was more efficient in generating larger areas of thermal ablation than either the consecutive or simultaneous monopolar modes.