October 11 2019:
The date of my first Thyroid RF of my patient with a large symptomatic thyroid nodule done in my office with my interventional radiologist technician. 40 ml thyroid nodule was causing the patients pressure symptoms and she did not like the look of the neck bulge. Office procedure that does not require hospital visit and is less expensive than similar procedure done by a radiologist in the hospital.All thyroid RF procedures are FDA approved but there are no codes and no insurance coverage. It is all an out of pocket expense to avoid thyroid surgery.
Here is the long winding trail from first thoughts of thyroid Rf to final everyday use in my center.
Today was the another episode in a 40 year crusade to find any and all ways to replace thyroid surgery in patients who can be treated with alternatives.
After a 5 year period of learning everything I could about radiofrequency ablation for thyroid disease I finally began treating patients from across the country in my center. The first two patients traveled from Chicago and Alabama to have their symptomatic larger thyroid nodules treated by me. Both were “pushed ” by their local physicians to have surgery.
Thyroid RF is a simple procedure done in my office with a lower cost than surgery or Thyroid RF done in the hospital setting by radiologists.
Here are the physicians and companies who aided my search for the how and why thyroid RF is the future for my thyroid patients.
1.Professor Jung Hwan Baek of Seoul Korea, the godfather of thyroid RF whose research papers on Thyroid RF since 2002 have inspired me to get involved. He kindly let me use his photos and extensive publications on Thyroid RF for my website. I sent patients to Korea to have the master treat them until I was up and running in the USA.
2.Next is Professor Roberto Valcavi in Italy who invited Dan Duick, Mark Lupo and I to come and spend a week with him learning thyroid RF in his thyroid center. He also turned me on to Star Med Korea for their generator system he used.He has treated my patients in his center. He has been my teacher and has helped me learn thyroid RF.
3. Next Star Medical Korea and their team taught me how to use their generator system and left a system for several years for me to practice and train endocinologists.They also sent a team of their best including Dr.Baek to the first meeting of the thyroid ablation society in the USA. I attended as guest of Star, a Hands on workshop during a radiology meeting also with Dr.Baek in Los Angeles. A personal meeting with my team including my website designer and Star’s Top management took place in my center in 2017 to consider how to coordinate Star move into US market. The long delay of Star getting FDA approval for their system and the feeling on both sides that with a new Korean distributor for the US we were not a good fit. The decision was mutual to go our separate ways. Star is a great company and I wish them luck in the US market.
4. Next my present company for Thyroid RF systems is RF Medical, another Korean maker of RF systems. I have used their system to train myself and other endocrinologists. I have used their system to do my first patient with a thyroid nodule in Rio Brazil during a hands on workshop with Brazilian experts.
5. Next is Rudy Garay. Rudy and I know each other for years as we met as instructors at AACE ultrasound workshops since the 90’s.His company RGS Healthcare (www.rgsheathcare.com )deals with RF Medical RF systems for the USA for endocrinologists, ENT and Surgeons. I am working closely with Rudy. He told me to go see Dr.L.Rangel and take his course which includes a chance to do thyroid RF on one of his patient during the workshop taught by a trio of expert thyroid interventional surgeons.The highlight was a full day doing RF on Dr.Rangel’s patients. After 5 years doing and teaching thyroid RF with models and phantoms, and watching experts do the procedure, I was able to do thyroid RF on a patient of Dr.Rangels. This was advanced training unavailable in the rest of the world.The highlight was a full day doing RF on Dr.Rangel’s patients. After 5 years doing and teaching thyroid RF with models and phantoms, and watching experts do the procedure,I was able to do thyroid RF on a patient of Dr.Rangel. This was advanced training unavailable in the rest of the world.
6. I left Brazil with a new outlook on thyroid RF. Not only was it easier than I thought but it had wider applications that just thyroid nodules.I learned that local Lidocaine properly placed on the thyroid capsule was all that you needed for pain. With the patient awake, I could monitor if she had symptoms.
7. The next physician to influence my career direction was a surgeon. Ralph Tufano, chief of Surgery at Johns Hopkins who was a guest speaker in Brazil and opened my eyes to other uses. Dr.Tufano does thyroid RF at Hopkins and uses it for thyroid nodules and also for parathyroid adenomas and micro-papillary cancers. He stated RF will replace surgery and active surveillance for micropapillary cancers and for some inferior located parathyroid adenomas. He stated that surgeons will become dinosaurs if they do not join in learning thyroid and parathyroid RF for their patients. Bravo from a surgeon with foresight to see the future of thyroid RF.
8. Finally the first company to give me a RF system to practice 5 years ago was Coveiden now Medtronic. They allowed me to try they system in my office. However, I found the system was not optimum for thyroid work. I tried to encourage them to work on a system with a narrow gauge and shorter electrode for thyroid work. They did not see any reason for them to invest in this as they had made a corporate decision to move on the microwave. They even canceled their 18 gauge prototype. Thank you Coveiden for getting me to look to Korea for thyroid systems.
9. Finally a shout out to my two buddies who put ultrasound on the map. Jack Baskin who taught me ethanol ablation.And Dan Duick who if he was healthy would be leading the charge to thyroid RF. He was with me in Italy 5 years ago and wrote the first draft of the clinical RF trial for thyroid nodules.
Thanks to all my mentors for getting me up to speed on this game changing procedure.
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