Pre-treatment to ensure the safety of the RF ablation treatment.
Pretreatment “hydrodissection technique”. For nodules of Grade 1-3.
Using sterile syringe, sterile water was injected between the thyroid nodules and surrounding tissues, until the nodules and surrounding tissues were completely separated.
Then the ablation was performed and during the ablation sterile water was continuously injected to ensure the completely separated status of the nodules from surrounding tissues (>2mm between nodules and surrounding tissues.
Here are the areas of the thyroid gland where nodules are too near vital structures to be done safely.
The risk assessment system for the ablation of benign thyroid Nodules.
Grade Location of Nodules
Grade 0, low risk: Nodules located in the thyroid, and the distance between nodule edge and adjacent important structures was ≥ 2 mm.
The nodule is well within the thyroid lobe and not near the thyroid capsule.
Grade 1, median risk: The distance between nodule edge and carotid sheath,anterior cervical muscles or cervical posterior muscles was less than 2 mm.
Grade 2, high risk:The distance between nodule edge and trachea, esophagus,
or recurrent laryngeal nerve was less than 2 mm.
Grade 3, Very high risk: Both Grade 1 and Grade 2 were existed.
Featured image shows separation of the carotid from the nodule on right after injection of dextrose.
All nodules are screened in my center for location near dangerous structures that could increase complication rates. If they are Grade 0 no dextrose is used. for all other grades dextrose is injected in the areas to separate the nodule before the treatment.
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