In vivo efficiency of four commercial monopolar radiofrequency ablation systems: a comparative experimental study in pig liver

Rationale and Objectives: To evaluate the efficiency of 4 radiofrequency (RF) systems by assessing the amount of delivered energy for each thermal induced lesion after perfusion mediated RF ablation and to compare the influence of perfusion mediation types on the energy efficiency. Methods: A total of 43 ablations in 16 male landrace pigs with 4 RF devices were performed strictly according to the manufacturers’ instructions. Total absorbed energy was computed and then related to 3D volumetry obtained after histopathological evaluation. Sixteen ablations were performed under physiological liver perfusion and 27 ablations with occlusion of portal vein, hepatic artery, or both vessels. Energy efficiency values of the RF systems for different vascular occlusion techniques were compared and analyzed by a nonparametrical rank sum test. Results: Under physiological perfusion, the average energy delivered to produce 1-cm3 lesion size was calculated to 1650 ± 929, 3097 ± 389, 8312 ± 2068, and 5493 ± 2306 Watt · s/cm3 for the Berchtold®, RadionicsTM, RadiotherapeuticsTM, and RITA® system, respectively. After perfusion-mediated RF ablation, artery occlusion was not as effective as portal vein occlusion, which reduced the energy to 587 ± 148, 869 ± 276, and 903 ± 394 Watt · s/cm3 for the Berchtold®, RadionicsTM, and RadiotherapeuticsTM system, respectively. The occlusion of vessels, portal vein, and artery or portal vein alone increased the energy efficiency compared with physiological liver perfusion or occlusion of the artery (P = 0,003). Conclusions: Under physiological liver perfusion the open perfused system and the internally cooled system provided the best efficiency values with lowest standard deviations. The energy efficiency was increased markedly for all systems after occlusion of the portal vein either alone or in combination with arterial occlusion. Occlusion of the hepatic artery did not improve the efficiency.