J Surg Ultrasound.  2019 May;6(1):20-26. 10.0000/jsu.2019.6.1.20.

Safety and Technical Efficacy of Tumescent Anesthesia in Radiofrequency Ablation for Thyroid Nodules Close to the Surrounding Structure

• Eom TI
• Kim BS

• KMID: 2465877
• DOI: http://doi.org/10.0000/jsu.2019.6.1.20

Abstract

PURPOSE
This study estimated the changes in distance between a thyroid nodule and the surrounding structures after tumescent anesthesia in radiofrequency ablation (RFA) for a benign thyroid nodule.
METHODS
Between January 2015 and December 2017, the sonogram images in patients treated with thyroid RFA were reviewed retrospectively. Patients without images immediately after tumescent anesthesia or treated with RFA for carcinoma were excluded. The 0.2% saline mixed lidocaine as a tumescent solution was injected into the anterior, posterior, and lateral capsules of the thyroid and thyroid-trachea junction. In a sonogram image, the distances between the posterior margin of the nodule and above the longus colli muscle, between the medial margin of the nodule and trachea, and between the lateral margin of the nodule and common carotid artery (CCA) were measured before and after tumescent anesthesia.
RESULTS
Tumescent anesthesia was technically successful in all 133 patients (100%) and the analgesic effect was also obtained successfully. No complications related to tumescent anesthesia were observed. The average distance between the posterior margin of the nodule and the longus colli muscle increased by 4.2 ± 2.4 mm. The average distance between the medial margin of the nodule and trachea increased by 2.2 ± 1.9 mm. The average distance between the lateral margin of the nodule and CCA increased by 4.6 ± 3.0 mm.
CONCLUSION
Tumescent anesthesia is a safe and useful method for secure a safe distance (over 2 mm) in RFA for thyroid nodules close to the surrounding structure.

Keyword

Radiofrequency ablation; Thyroid; Anesthesia; Injection

MeSH Terms

Anesthesia*
Capsules
Carotid Artery, Common
Catheter Ablation*
Humans
Lidocaine
Methods
Retrospective Studies
Thyroid Gland*
Thyroid Nodule*
Trachea
Capsules
Lidocaine

Figure

• 

  Fig. 1 The distances between nodule and major structures were measured on PACS image before and after tumescent anesthesia using same method. CCA = common carotid artery.

Reference

Spiezia S., Garberoglio R., Milone F., Ramundo V., Caiazzo C., Assanti AP, et al. 2009. Thyroid nodules and related symptoms are stably controlled two years after radiofrequency thermal ablation. Thyroid. 19:219–25. DOI: 10.1089/thy.2008.0202. PMID: 19265492.

Cesareo R., Pasqualini V., Simeoni C., Sacchi M., Saralli E., Campagna G, et al. 2015. Prospective study of effectiveness of ultrasound-guided radiofrequency ablation versus control group in patients affected by benign thyroid nodules. J Clin Endocrinol Metab. 100:460–6. DOI: 10.1210/jc.2014-2186. PMID: 25387256.

Jeong WK., Baek JH., Rhim H., Kim YS., Kwak MS., Jeong HJ, et al. 2008. Radiofrequency ablation of benign thyroid nodules: safety and imaging follow-up in 236 patients. Eur Radiol. 18:1244–50. DOI: 10.1007/s00330-008-0880-6. PMID: 18286289.

Ha EJ., Baek JH., Lee JH., Kim JK., Shong YK. 2011. Clinical significance of vagus nerve variation in radiofrequency ablation of thyroid nodules. Eur Radiol. 21:2151–7. DOI: 10.1007/s00330-011-2167-6. PMID: 21633824.

Baek JH., Lee JH., Sung JY., Bae JI., Kim KT., Sim J, et al. Korean Society of Thyroid Radiology. 2012. Complications encountered in the treatment of benign thyroid nodules with US-guided radiofrequency ablation: a multicenter study. Radiology. 262:335–42. DOI: 10.1148/radiol.11110416. PMID: 21998044.

Wang JF., Wu T., Hu KP., Xu W., Zheng BW., Tong G, et al. 2017. Complications following radiofrequency ablation of benign thyroid nodules: a systematic review. Chin Med J (Engl). 130:1361–70. DOI: 10.4103/0366-6999.206347. PMID: 28524837. PMCID: PMC5455047.

Cosman ER Jr Jr., Dolensky JR., Hoffman RA. 2014. Factors that affect radiofrequency heat lesion size. Pain Med. 15:2020–36. DOI: 10.1111/pme.12566. PMID: 25312825.

Kim JH., Baek JH., Lim HK., Ahn HS., Baek SM., Choi YJ, et al. 2018. 2017 thyroid radiofrequency ablation guideline: Korean Society of Thyroid Radiology. Korean J Radiol. 19:632–55. DOI: 10.3348/kjr.2018.19.4.632. PMID: 29962870. PMCID: PMC6005940.

Levit E., Bruners P., Günther RW., Mahnken AH. 2012. Bile aspiration and hydrodissection to prevent complications in hepatic RFA close to the gallbladder. Acta Radiol. 53:1045–8. DOI: 10.1258/ar.2012.120190. PMID: 22855419.

Conroy PH., O'Rourke J. 2013. Tumescent anaesthesia. Surgeon. 11:210–21. DOI: 10.1016/j.surge.2012.12.009. PMID: 23375489.

Park HS., Baek JH., Park AW., Chung SR., Choi YJ., Lee JH. 2017. Thyroid radiofrequency ablation: updates on innovative devices and techniques. Korean J Radiol. 18:615–23. DOI: 10.3348/kjr.2017.18.4.615. PMID: 28670156. PMCID: PMC5447637.

Lim HK., Baek JH., Lee JH., Kim WB., Kim TY., Shong YK, et al. 2015. Efficacy and safety of radiofrequency ablation for treating locoregional recurrence from papillary thyroid cancer. Eur Radiol. 25:163–70. DOI: 10.1007/s00330-014-3405-5. PMID: 25199815.

Laeseke PF., Sampson LA., Brace CL., Winter TC 3rd., Fine JP., Lee FT Jr Jr. 2006. Unintended thermal injuries from radiofrequency ablation: protection with 5% dextrose in water. AJR Am J Roentgenol. 186(5 Suppl):S249–54. DOI: 10.2214/AJR.04.1240. PMID: 16632684.

Raman SS., Lu DS., Vodopich DJ., Sayre J., Lassman C. 2002. Minimizing diaphragmatic injury during radio-frequency ablation: efficacy of subphrenic peritoneal saline injection in a porcine model. Radiology. 222:819–23. DOI: 10.1148/radiol.2223001805. PMID: 11867807.

Liu CH., Yu CY., Chang WC., Dai MS., Hsiao CW., Chou YC, et al. 2016. Computed tomographic-guided percutaneous radiofrequency ablation with hydrodissection of hepatic malignancies in the subcapsular location: evaluation of safety and technical efficacy. J Chin Med Assoc. 79:93–100. DOI: 10.1016/j.jcma.2015.07.013. PMID: 26507775.

Hisham AN., Lukman MR. 2002. Recurrent laryngeal nerve in thyroid surgery: a critical appraisal. ANZ J Surg. 72:887–9. DOI: 10.1046/j.1445-2197.2002.02578.x. PMID: 12485227.

Shindo ML., Wu JC., Park EE. 2005. Surgical anatomy of the recurrent laryngeal nerve revisited. Otolaryngol Head Neck Surg. 133:514–9. DOI: 10.1016/j.otohns.2005.07.010. PMID: 16213921.

Bliss RD., Gauger PG., Delbridge LW. 2000. Surgeon's approach to the thyroid gland: surgical anatomy and the importance of technique. World J Surg. 24:891–7. DOI: 10.1007/s002680010173. PMID: 10865032.

Klein JA., Jeske DR. 2016. Estimated maximal safe dosages of tumescent lidocaine. Anesth Analg. 122:1350–9. DOI: 10.1213/ANE.0000000000001119. PMID: 26895001. PMCID: PMC4830750.