Canvasser Noah E, Lay Aaron H, Koseoglu Ersin, Kavoussi Nicholas, Sorokin Igor, Gahan Jeffrey, Lucas Elena, Cadeddu Jeffrey A
1 Department of Urology, University of Texas Southwestern Medical Center , Dallas, Texas.
2 Department of Pathology, University of Texas Southwestern Medical Center , Dallas, Texas.
J Endourol. 2018 Apr;32(4):338-343. doi: 10.1089/end.2017.0495. Epub 2018 Jan 30.
Irreversible electroporation (IRE) is a new ablative technology to treat small renal masses. We evaluated differed ablation settings on lesion size and temperature changes in a porcine model.
After Institutional Animal Care and Use Committee approval, 36 laparoscopy-guided and 16 open ablations were performed on 13 domestic female pigs. Ablation parameters studied were voltage (1000 V/cm, 1500 V/cm, or 2000 V/cm), probe exposure (1.0 or 1.5 cm), and lesion size over time (survival) (0-, 7-, or 14 day). Temperature changes were monitored during open ablations with differed settings. Gross lesion size was measured, and histologic analysis with hematoxylin and eosin and nicotinamide adenine dinucleotide staining was performed.
The 1000 V/cm ablations had no gross or histologic lesions. A factorial analysis of variance demonstrated that day (p = 0.56), exposure (p = 0.33), and voltage (p = 0.06) did not demonstrate statistical significance for affecting lesion size. For 1.0 cm probe exposure, 2000 V/cm did more closely approximate expected lesion size (p = 0.02) compared with 1500 V/cm. While significance was not seen for 1.5 cm probe exposure, 2000 V/cm often exceeded expected lesion volume. Only 1 of 4 temperature sensors, located adjacent to one of the IRE probes, noted a significant increase with increased voltage. However, all maximum temperatures remained less than 70°C.
Variation in lesion volume was seen with different ablation settings in this porcine model. Maximal energy and probe exposure settings should be utilized to ensure full coverage of target volume/mass, potentially without concern for thermal injury to renal collecting system or nearby structures.
不可逆电穿孔（IRE）是一种治疗小肾肿块的新型消融技术。我们在猪模型中评估了不同消融设置对病灶大小和温度变化的影响。
经机构动物护理和使用委员会批准，对13头家养雌性猪进行了36次腹腔镜引导下消融和16次开放消融。研究的消融参数包括电压（1000V/cm、1500V/cm或2000V/cm）、探头暴露长度（1.0或1.5cm）以及不同时间（存活期）（0天、7天或14天）的病灶大小。在开放消融过程中，使用不同设置监测温度变化。测量大体病灶大小，并进行苏木精-伊红染色和烟酰胺腺嘌呤二核苷酸染色的组织学分析。
1000V/cm的消融未产生大体或组织学损伤。方差分析表明，时间（p = 0.56）、暴露长度（p = 0.33）和电压（p = 0.06）对病灶大小的影响无统计学意义。对于1.0cm的探头暴露长度，与1500V/cm相比，2000V/cm更接近预期病灶大小（p = 0.02）。虽然对于1.5cm的探头暴露长度未发现显著性差异，但2000V/cm常常超过预期病灶体积。位于一个IRE探头附近的4个温度传感器中只有1个显示随着电压升高有显著升高。然而，所有最高温度均低于70°C。
在该猪模型中，不同消融设置可见病灶体积的变化。应采用最大能量和探头暴露设置，以确保完全覆盖目标体积/肿块，可能无需担心对肾集合系统或附近结构造成热损伤。
