Thyroid Radiofrequency Ablation Course
Santa Monica Thyroid Center
Richard Guttler MD,FACE,ECNU
Radiofrequency Thyroid Tumor Ablation Workshop
Introduction to thyroid tumor ablation
Lectures on present state of RFA in the world
Lecture on the RFA literature, Uses and
SOP for doing RFA in your endocrine practice office.
List of equipment needed including the electrode
“Knobology” How to use of generator, cooling pump, grounding pads and electrodes.
Prepare models for RFA practice when you get your generator.
Bovine Liver with assorted size “beef” nodules
Nodules sewn in to pockets in the liver.
Simulating thyroid nodules and primary
Micro-papillary and lymph node cancers and parathyroid adenoma.
The RFA ultrasound room set up.
Ice saline cooling pump to cool the electrode.
Grounding pads for monopolar electrodes.
Why are they needed?
Proper placement of the grounding pads to prevent skin burns.
Generator 101 the basics.
3, 5, 7 and 10 mm hot tips on an #18 or 19 electrode.
High resolution Ultrasound to monitor the
tip during the treatment. ultrasound anatomy of the neck structures including nerves and blood vessels.
Mark the inferior and superior extent of the “beef nodule.
Mark the middle with an X. This is the entry point for the electrode.
Begin RFA practice with 10, 20, 30 ml “beef nodules”.
Learn how to use lidocaine on the peri-thyroid capsular space
with water injection of “capsule simulation” on a water balloon or “beef nodule”
Use the original insertion hole at the X to inject the capsule to put the electrode into the nodule at the isthmus.
Learn how to use microdissection with dextrose infusion to move the nodule away from dangerous structures. Recurrent nerve etc.
Learn “moving shot” technique by practice on Ace Needle ME
torso and on Bovine liver.
Learn how to avoid the danger triangle.
Protocol for RFA ablation begins with electrode
positioning at the inferior posterior of the “nodule”
Foot pedal controls the on/off of the hot tip.
Iced saline is continuously circulating around the tip.
With the electrode in position turn on the heat.
Usually 20-50 watts is all you need to ablation
the “beef nodule”.
Now slowly pull the electrode back
under complete US vision until you have ablated this area.
Turn off and re-position to the anterior position away
from the micro-bubbles formed posterity.
Turn on and do the anterior section.
Continue this without removing the electrode from the nodule.
Also make sure the electrode is off 5 mm from the capsule to prevent nodule rupture.
Repeat the same to the middle of the nodule
and then the Superior part of the nodule.
The “beef nodule” ablated is removed and dissected to see how well you did with your first try. Continue on the other
Beef nodules and small “lymph nodes and micro-cancer “nodules.
Practice doing a “ beef parathyroid adenoma” with hydro-dissection.
Never use saline during a real case as saline conducts electricity.
After you are done again dissect the nodules to see the
Ablated areas in the nodule are not through nodule surface.
All day workshop
Practice Everything learned on Day One
RFA practice technique
Lidocaine capsule method
Hydro-dissection Method with dextrose.
Cancer lymph nodes
Observation of 1-2 actual cases done by Dr.Guttler
Final review and questions
Master’s class Diploma ( No CME )
Call Alicia at 310-393-8860 or [email protected]