Thyroid Ablation Master Class 101: What is involved in my one on one thyroid ablation class?
1.Master’s Class Teachers
Richard B. Guttler MD,FACE,ECNU ( Dr.G.)
Matthew Foss Thyroid Sonographer
2. Location: 1328 16 street Santa Monica CA 90404
3. Class Program
7:30 Dr.G. picks up at your hotel. Casual discussion about the plans over Italian style breakfast( roll and espresso )
8:00 Orientation of the center facilities.
9:00-11 Lectures on Endocrine Neck thyroid Ultrasound, USGFNA, needle placement, collecting sample, 4 methods of adding sample to slides, smearing technique.
11:00-12 Hands on workshop on everything from the morning lecture.Using models and AACE’s own AceNeedle Me USG needle placement, Using parallel approach to sampling instead of perpendicular in preparation for interventional methods and smearing practice with white Lubriderm Lotion simulated samples. Practice the 4 methods of collection. 1 step,snap,pop, and 2 step. Take a box of slides to the hotel and practice slide making. Bring results to office the next day. See new patient candidates for FNA, PEI or RFA referral to Korea or Italy.
1:00-2 Lectures on On-Site adequacy by endocrinologist ( eROSE ), value of smears over liquid prep. Lecture on cytology for endocrinologists. Microscope 101 for those who have not used one since med school.
2-5 PM On-site slide making with air dried smears, microscope slide review of on-site cases for adequacy and even for a quick diagnosis occasionally. Slide thyroid case packets with history and diagnosis on the back.
8:00 to 9 Review of the slides made on Monday night. Lectures on USGFNA, Molecular markers,thyroid biopsies,parathyroid biopsy,thyroid cancer lymph node biopsy, and location of needle placement for complex cysts to hit the acute angle solid areas.
9-12 Patients seen in follow up or new.
1-2 Lectures on the field on interventional thyroidology. PEI, RFA, HIFU, MWA will be covered with main direction to PEI and RFA.
2-5 Workshop on the proper methods to direct the needle by parallel and perpendicular approaches. In preparation for interventional methods parallel approach must be learned using DR.Dev Abraham’s gelatin model with “cysts” and “solid nodules” and blue phantom models. Ace Needle ME torso will also be used.
8:00-9 Lecture on PEI literature and advances such as using PEI for not only thyroid and parathyroid cysts but for lymph nodes and primary micro-papillary thyroid cancer. Dr.Ian Hay’s recent presentation of PEI for primary micro-papillary cancer as alternative to active surveillance.
9-11 Patient candidates for ablation procedures or referral. Patients in follow up from prior PEI treatment.
Actual patients for pre-PEI/RFA USGFNA and molecular markers and PEI treatment.
11-12 Demo on proper preparation for PEI, including consent,ethanol, set up and actual PEI injection technique. Also the danger areas of this procedure.
12:00-1 lunch informal discussion of the PEI before workshop
1-2 DR.G Actual PEI demo on models.
2-5 Workshop What can go wrong and complications discussed.Actual workshop for the student to practice PEI of large cysts and “pseudo-small cancer lymph nodes”
8:00-9 Lecture on RFA and Dr.JH Baek’s contribution to the field.
9-11 Introduction to Interventional thyroid tumor ablation with RFA. Generator, probes,cooling system, consent,complications, and danger areas of the procedure.New helpful aides to help with tip location and ways to avoid dangerous structures, improve heat delivery, and ways to completely ablate the nodule with one session. Other uses include palliation of advanced recurrence of thyroid cancer in combination with External beam radiation, ablation of micro-papillary thyroid cancers, and relief of symptoms and airway obstruction in massive benign goiters.
11-12 patient examinations
12 lunch Discuss referral system to Dr.Roberto Valcavi in Italy or Dr.J H Baek in Korea for RFA until we can use it in the USA.
1-2 DR.G. using AceNeedleME torso and cow liver with “beef” nodules of various sizes inserted demonstrates parallel method called “moving shot technique”.
10 mm burn area shown on the surface of the liver
2-5 RFA workshop #1 Student uses Ace Needle Me to practice positioning and moving shot method of an actual patient with the torso model and regular 22 spinal needles using a parallel approach. Then the cow liver is used to inject “lidocaine” water along the thyroid capsule above the “beef nodule” to be treated before the procedure begins. This is simulated with the use of cysts models.
Simulation of capsule injection with Lidocaine
Actual Lidocaine injection of the thyroid capsule before RFA.
The entry hole for the “lidocaine” is also the entry way for the electrode. The generator and the cooling system is turned on and the low wattage of 30-40 is all that is needed for this ablation practice. USG RFA is begun aiming the electrode to the inferior/posterior of the nodule.
In a sequence from inferior/posterior to inferior anterior 10 mm sections are ablated. The electrode is moved from the same starting hole to the middle of the nodule and the ablation is again middle inferior to middle anterior. Final positioning is to aim the electrode to the superior inferior area of the nodule, and repeat the moving shot from superior/inferior to superior anterior. When all the “nodules and Lymph nodes are ablated the liver is moved and the nodules removed and examined for completeness of the ablations without extending outside the nodule capsule. Practice until 5:00 Pm.
The image above show the location of the danger triangle ( yellow dot ) which this method is designed to be away from the area
and use smaller burns near it.
Moving Day; Discussion of what it takes to open a thyroid only ablation practice.
Student tells me what they need to work on before the end of the course.
Most spend the time with models doing parallel approach if they used the other method in their FNA work.
PEI for cysts and lymph nodes and primary micro-papillary cancers is another thing they want more time on.
Finally most want more time on the RFA on cow liver.
Any more patients for PEI, or FNA done in the afternoon.
3 PM Final gross pathology examination of their nodule ablations.
British traditional farewell toast with Sherry,Tea, or Whiskey.
Presentation of their Masters Class Diploma in Interventional Thyroid Tumor Ablation
Dr. Brittany Henderson, clinical thyroidologist seen getting her diploma after 5 days course.
Her review of the Master’s class she attended in June 2017
I attended Dr. Guttler’s Master Class as someone who has been interested in thyroidology since medical school. My current clinical practice largely focuses on thyroid disease and thyroid cancer, performing an average of 300 FNA biopsies and 800 thyroid ultrasounds and lymph node mappings annually. Dr. Guttler’s master’s class was instrumental in my learning of advanced noninvasive thyroid interventional techniques. During the 5-day course, we reviewed and practiced percutaneous ethanol ablation for thyroid cysts and recurrent thyroid cancer lymph nodes and radiofrequency ablation (RFA) for thyroid nodules. Dr.Guttler uses a wide array of real-time patient encounters, follow-up patient visits to assess the impact of therapy, various modeling techniques, simulation labs, high-level videos, and tutorial sessions geared toward learning these non-invasive techniques. Since attending the course, I have been able to successfully integrate theses advanced practices into my own clinical thyroid practice. I highly recommend Dr. Guttler and his Masters Course to anyone wanting to become an expert in thyroid clinic practice.
Location: 30 minutes to Los Angeles International airport.
Recommended Motel Best Western at 20 and Santa Monica blvd. 4 Blocks from my office on the main #1 blue bus line.
Restaurants: Fish Santa Monica seafood,Meat Belcampo, Desserts Huckleberry, Italian Forma, feet in the sand as you eat lunch Back of the Beach.
Costs: $5000 paid in 2 installments 50% when booking and the rest 2 weeks before the class. Many get their hospital system to pay the fee, and others want to start their own practice soon.
Call or email Matt at 310-393-8860 or