Specialist ENT RADIOFREQUENCY ABLATION

COBLATION

Introduction:  Radiofrequency (RF) ablation is a minimally invasive procedure that has emerged as the most powerful percutaneous technique for tissue destruction and is nowadays established as the primary ablative modality at most institutions. The goal of RF ablation is to induce thermal injury to the tissue through electromagnetic energy deposition. The term Radiofrequency refers not to the emitted wave but rather to the alternating electric current that oscillates in this frequency range.

Basic Principles:

I. Radiofrequency needle is inserted into the tissue percutaneously.

II. Coagulation is induced by all electromagnetic energy sources with frequencies less than 900 kHz, although most devices function in the range of 375–500 kHz.

III. In monopolar RF ablation, the patient is part of a closed-loop circuit that includes an RF generator, an electrode needle and a large dispersive electrode (ground pads).

IV. An alternating electric field is created within the tissue of the patient. Because of the relatively high electrical resistance of tissue in comparison with the metal electrodes, there is marked agitation of the ions present in the target tissue that surrounds the electrode, since the tissue ions attempt to follow the changes in direction of the alternating electric current. The agitation results in frictional heat around the electrode. The discrepancy between the small surface area of the needle electrode and the large area of the ground pads causes the generated heat to be focused and concentrated around the needle electrode.

V. The thermal damage caused by RF heating is dependent on both the tissue temperature achieved and the duration of heating.

    ➣ Heating of tissue at 50–55°C for 4–6 min produces irreversible cellular damage.

    ➣ At temperatures between 60°C and 100°C near immediate protein coagulation is induced, with irreversible damage to mitochondrial and cytosolic enzymes as well as nucleic acid-histone protein complexes.

Specialist ENT Screenshot 2020 11 29 book near final miscellaneous19
Specialist ENT Screenshot 2020 11 29 book near final miscellaneous20

Goals of Radiofrequency ablation:

The ultimate goal is tissue reduction that occurs in two stages-

    i. Contraction of the area by fibrosis.

    ii. Resorption which occurs over several months further reduces the volume of the tissue.

Indications:

Used in obstructive sleep apnea and snoring for procedures like

i. Palatoplasty.

ii. Inferior turbinoplasty.

iii. Reduction of tonsillar tissue.

iv. Reduction of tongue base.

Radiofrequency Ablation is safe, effective and has shown to be a great alternative to CPAP.

Specialist ENT Screenshot 2020 11 29 book near final miscellaneous21

Advantage of Radiofrequency ablation over other sleep apnea surgeries:

In contrast to other obstructive sleep apnea surgeries, the radiofrequency ablation procedure has a far shorter recovery time and significantly less post-operative pain. It is done under local anesthesia. The recovery time for other OSA surgical procedures is typically several weeks with the accompaniment of narcotics, while the recovery time for radiofrequency ablation procedure is only a few days. This procedure has shown consistent positive results as being a sleep disorder cure for obstructive sleep apnea.

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