Radiofrequency ablation Parathyroid Adenoma

Posted August 3, 2021 by Dr Guttler

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Alternative to surgery?

25 patients who were treated with RFA for pHPT in this report.
21/25 had normal PTH at 6 months.
Minor complications of neck pain and one case of transient voice change.
The used hydrodissection to set a 5 mm barrier between the PTA and vital structures. They injected 10-30 ml normal saline in order to avoid thermal injury of critical structures by forming a liquid isolation zone greater than 5 mm between the parathyroid

and adjacent structures.
I do not use saline as it is an conductor of electricity. I use dextrose instead.
RFA was performed using the moving-shot technique and trans-

isthmic approach.
The RFA power was 3-7 Watts.
If a transient hyperechoic zone did not form at

the electrode tip within 5–10 s, the radiofrequency power was gradually increased.
Failed response occurred with a larger size adenoma and if multiple glands were involved.
Ideal size for RF ablation is around 1 cm.
Very small PTAs <0.6 cm are also more difficult to ablate.
The procedure takes about 5 minutes.