THERMAL ABLATION TATO SYSTEM Laura Sarti Product Specialist 1 - PowerPoint PPT Presentation

THERMAL ABLATION TATO SYSTEM Laura Sarti Product Specialist 1

Definition Thermal Ablation (TA) is the use of extreme hiperthermic temperatures to destroy diseased tissues. T.A. is performed in Interventional Radiology as an alternative to the surgical treatment of tumors in: 2

Different TA technologies • Radiofrequency • Microwaves • Laser • Cryoablation 3 3 3

RF Current Flow • RF Currents that goes through the tissue from the tip of the applicator to the ground pad . Side effect: skin burning. 4 4

MW Energy Microwaves radiate only near the tip of the applicator. An applied MW field causes water molecules to rotate bilions of time per second , which leads to heat generation. 5

Comparison between RF and MW thermal ablation • Heat sink effect • Less influenced by veins • Ground pad required • Ground pad is not required • Difficult to control the increase • Predictable and controllable ablation 6 • Compatible with pacemaker of ablation

TATO : Multiprobe microwave thermal ablation System 7 Rev. 09 del 27.10.2016

Main features of the system • No cooling system 1 • Ergonomic and easily transportable 2 • Multi-probes with detachable cable 3 8

1. No cooling system The NIC (Not Internally Cooled) coax needles have a high energy efficiency that allows operating with less MW power for treatment up to 15 minutes. Cooling system not needed Less complexity Higher reliability Greater safety Better applicator handling 9 Reducing procedure dead time Easy control of the procedure

2.Ergonomic and easily transportable Tato cart version Tato travel version Main Unit- Microwave generator Articulated Arm extendable up to 1,5 m Switch Unit Roll Stand Roll Stand Switch Unit 10

Main unit Handle USB port 2,45 GHz 120 W total power IEC standards On/off button compliant Yellow Led: lighting indicates that MWs Touchscreen are ON 7,1 inch 11 Red Led: when lighting up, it indicates a fault

Extendable arm and switch cover Sterile cover for arm Extendable up to 1.5 m • Total power 120 W 12 • 1 to 4 power outputs

TATO1 vs TATO2 FEATURE TURES TATO1 O1 TATO2 O2 TOTAL POWER 100W 120W  DATA LOGGING  DATA DOWNLOAD  TRACK ABLATION PROTOCOL  REFLECTED POWER MONITORING  SELECTION NEEDLE GAUGE 13

Multi-Gauge 11 G 14 G 17 G 18 G 14

DIAMETER G mm 3 mm 11 G 2,1 mm 14 G 1,5 mm 17 G The thinnest applicator currently 1,2 mm 18 G available in the world market 15

Version with infusion tip • 14 G and 17 G version • Applicator with 4 micro-holes in the tip for fluid infusion • A syringe can be used to inject fluids during the treatment Holes 0,3 mm Ø 16

Main structural features • Simple radiating monopole • High efficiency • Lightweight (~35g w/o cable, 50g w/cable) • Detachable feeding cable: advantage under CT scan 17

Massa - Patient with HCC  Usability of TATO under CT-scan  Extendable arm 18

Echogenic needle 19

Video of needle insertion 20

Main structural features • All steel tips are tested with an applied force of 5kg. • No fragile ceramic parts are used • All probes are Teflon covered , non-sticky. • Available in different lengths from 10 up to 50 cm. • Centimeter marked cannula 21

How to insert the needle E Lesion Ablation E Insert the tip of the needle into the lesion and use length E parameter (indicated in the chart) 22 as reference.

Main functional features Control of increasing ablation volume : By employing lower MW power, the procedure’ s safety is increased, thus eliminating a lot of bubble gas and ensuring a better control under ultrasound. In order to operate safely, antennas must be used respecting the assigned power limits: Gauge ge Max power er W 11 11 60 14 14 40 17 17 30 23 18 18 15

Increasing ablation 24

TATO 2 HMI 25

TATO2 HMI Home Screen 26

Setting Output mating cycles : Language 1 Date and time 2 LOG Download 3 4 Services 27

TATO2 Home Screen 28

Possibility to insert Patient ID, Physician ID and note 29

Needle choice 30

Therapy Setting 31

Therapy summary 32

Therapy running REFLECTED POWER COEFFICIENT OK : NEEDLE IS WORKING WELL AIR : NEEDLE IS IN THE AIR MISMATCH : NON-OPTIMAL FUNCTIONING OF NEEDLE NOT CONNECTED : NEDDLE IS NOT CONNECTED 33

Therapy ended - Summary TRACK ABLATION 34

Track Ablation 35

Video for Track ablation • 14 G, 60 W, 25 sec 36

Ex – vivo and in – vivo charts of Tato System 37

CHARTS TATO2 ABLATION ZONE EXAMPLES* – 1 APPLICATOR Ex – vivo Bovine Liver 11 G 60 W Duration (min) 10:00 15:00 L (cm) 6,0 7,0 D( cm) 4,3 5,0 E (cm) 1,3 1,5 14 G 40 W Duration (min) 5:00 10:00 15:00 L (cm) 5,0 5,4 6,2 D( cm) 2,6 4,0 4,5 E (cm) 0,9 1,0 1,1 17 G 30 W Duration (min) 5:00 10:00 15:00 L (cm) 4,6 5,0 5,6 D( cm) 2,5 3,4 3,8 E (cm) 0,8 1,0 1,2 18 G 10 W 15 W Duration (min) 5:00 10:00 5:00 10:00 L (cm) 2,0 2,6 2,3 3,3 38 D( cm) 1,4 1,7 1,5 2,3 E (cm) 0,4 0,6 0,6 0,6

CHARTS TATO2 39

CHARTS TATO2 40

CHARTS TATO2 41

E.g. HCC or liver metastasis • Examples of MW applications in different liver tumors with same values of watt and time. • HCC : «oven effect» due to the tissue’s consistency that is rich in water and to the encapsulated tumor’s morphology . The result is a bigger ablation. • Metastasis : no «oven effect» because of the tissue has less water content and is not encapsulated. The result is a smaller ablation. 42

Frequently used parameters In vivo most frequently used values of power (W) and time (min) • D = diameter Diamet eter er 0,5 <D<1 1<D<2 2<D<2,8 2,8 <D<4 D>4 of tumor Gauge 11 11 1 needle 2 needles 60 60 W 10 min 15 min Open surgery 14 14 1 needle 1 needle 2 needles 3 needles 40 40 W 10 min 15 min 15 min 15min 4 needles 10 min 17 17 1 needle 2 needles 30 30 W 10 min 15 min 43 18 18 1 needle 15W 15W 10 min

Microwave ablation system Cross- reference 44

Padova – TATO use in laparoscopy • Lesion: 7 cm • 2 x 14 G, 35 W, 15 min • And Repositioning 1 x 14G, 35 W, 4.5 min 45

Treatment on HCC (percutaneous) Dimension of the tumor 5 X 3 cm Used 2 x 17G 46

Padova – Open surgery 9 tumors in total  RESECTION AND ABLATION Data of the first 4 ablations: 18 mm, 35W, 10min 19 mm, 35W, 2.3min and 40W, 1.30min 20 mm, 40W, 6min 18 mm, 40W, 6.2min 47

Osteoid osteoma O steoid osteoma in vertebra 18G, 10W, 6min 48

Aarau - Patient with kidney tumor Multi-probe case Tumor size: 2.4 x 2.2 cm (+2 cm margin) Number of antennas: 4 x 14G Power: 100W total Time: 15min 49

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