Radiofrequency ablation

Radiofrequency ablation (RFA) involves the use of heat in the form of electric current or radio waves on affected tissues/area to destroy it. The procedure is used to treat various conditions, such as varicose veins, arrhythmia, enlarged prostate and tumours. The procedure may vary depending on the condition to be treated and the location of the tissue. For example, in case of varicose veins, heat energy is applied to collapse the wall of and seal the varicose veins. This action will prevent the blood flow to the veins. The blood then gets directed through other healthy veins in the region. On the other hand, enlarged prostate may be treated by inserting a camera-based device called a cystoscope through your penis. The surgeon will then apply heat to shrink your prostate and allow the passage of urine through your urethra. The whole procedure is done under the guidance of an MRI, CT scan, ultrasound or X-ray imaging. 

Your surgeon may recommend this procedure for the management of one of the following conditions: 

• Varicose veins
• Benign prostate hyperplasia (BPH) or enlarged prostate
• Sleep apnoea 
• Severe nerve pain 
• To remove the areas of the heart that are responsible for irregular heartbeats 
• Decreasing the size of cancerous tumours. This procedure is done when the cancer is not responsive to any other surgery or chemotherapy.

Your doctor may not perform this surgery for varicose veins if you:

• Have an untreated infection in legs 
• Are pregnant
• Are unable to move or walk (non-ambulatory)
• Have an increased tendency for blood clotting
• Have blocked drainage in deep veins

Additionally, the relative contraindications for which the surgery may be done, but with precautions, are as follows:

• Ongoing contraceptive pills or hormone replacement therapy (as directed by the doctor)
• Peripheral arterial insufficiency (narrowing of the blood vessels in the limbs leading to insufficient blood flow) 
• Inability to wear compression stockings
• Difficulty in placing the RFA tube

In the case of BPH, this surgery is contraindicated under the following conditions:

• Bleeding disorder
• Presence of prostate cancer or bladder cancer 
• Active (ongoing) urinary tract infection 
• Too small (less than 34 mm) or enlarged (more than 80 mm) prostate 
• Use of non-medicinal therapies for prostate 
• Urethral strictures (restriction) or muscle contraction that prevents insertion of the device through the penis 
• Atonic (unable to contract completely) bladder 

This surgery may not be performed for sleep apnoea if you have:

• Thyroglossal tract remnants (neck swelling that arises due to infected cyst in the thyroglossal tract, the area of development of the thyroid gland) 
• Other sleep disorders like insomnia 
• Presence of obstruction in the nose 
• Pregnancy 
• Overweight (body mass index more than 30kg/m²)
• Periodic limb movement disorders 

The following preparations will be needed before the surgery:

• Your healthcare provider may ask you to undergo the following tests before this procedure:
  • Magnetic resonance imaging scan, ultrasound and X-ray scans (for detailed images of internal organs)
  • Electrocardiogram (for assessing electrical activity)
  • Blood tests
• You need to share a list of all your current and previous medicines with your doctor. This list should also include prescribed, illegal drugs, over-the-counter medications, herbs, vitamins and supplements.
• If you are pregnant or suspect you are pregnant, you should share it with your healthcare practitioner.
• You will have to fast for at least six hours before the surgery until the doctor approves you for the next meal. 
• You will be asked to stop taking blood thinners (like aspirin) for at least 11 days before this procedure.
• Arrange for someone to drive you home after the surgery.
• Stopping alcohol and smoking can help in speeding up your recovery after the procedure.
• If you agree to the procedure, your doctor will ask you to sign a consent form.

After your admission at the hospital for the surgery:

• The medical staff will assist you in changing your clothes into a hospital gown. 
• You will be requested to lie on the operating table. 
• A nurse will start an intravenous line in your arm to supply all the necessary medicines and anaesthesia.
• Someone from the surgery team will clean the area to be operated with an antiseptic solution. This will help prevent infection. 
• An anaesthetist will inject local anaesthesia to you to numb the area of surgery. Additionally, you will need sedative drugs to feel relaxed throughout the surgery.
• The surgeon may use an imaging scan method such as MRI for this procedure.

The exact procedure will depend on the location of the abnormal tissue. Under the guidance of an MRI, CT scan, x-ray or ultrasound, the surgeon will place a needle with a probe at the target area directly or through a catheter. He/she will use electric current to heat the needle and destroy the targeted tissue.

Varicose veins: Once your leg is numb, the surgeon and his/her medical team will perform the following steps to treat varicose veins:

• The surgeon will make a small hole in the affected vein with the help of a needle and then insert the RF device inside the vein through a catheter tube. 
• After the catheter is correctly positioned, the surgeon will pull it back through your vein. 
• This action will heat your veins and seal them. 
• The surgeon may make more small cuts to remove side branches of the varicose veins. 
• Once the veins are closed, the surgeon will remove the catheter tube and apply pressure on the area to stop the bleeding. 
• The surgical team may place a bandage or an elastic compression stocking on your leg.

For BPH, the following steps will be performed:

• The surgeon will insert a cystoscope into your urethra through the tip of your penis. 
• Using this instrument, he/she will then insert tiny needles inside your prostate. 
• Once the needles are in place, the surgeon will pass radio waves through them. 
• These waves will produce heat and shrink your prostate by destroying some tissues.
• After the procedure, the surgeon will carefully remove the cystoscope.
• Finally, he/she will insert a catheter tube inside your bladder to remove urine until the surgical area heals.

Similarly, for sleep apnoea, the healthcare provider may apply heat to remove tissues from inside your mouth or throat.

It may take about 45-60 minutes to complete this procedure. After the surgery, you will be kept in the recovery room until your vitals stabilise. Usually, patients are discharged on the same day of the procedure. However, in case of certain complications, the doctor may extend your hospital stay. The catheter tube may be removed within one to three days after the surgery.

Once you are home, the following things should be taken care of:

• Medications: 
  • You will be prescribed pain-killer medications for a few days after the surgery, which should be taken as per schedule. 
• Stockings and bandage care:
  • Keep on the bandage for a day and then wear the stockings for support after the surgery.
  • Wear the stockings for at least two weeks following the surgery (these stockings must be removed before sleeping or during shower or bathing). You must not roll your stockings down
• Activities: 
  • Keep your leg elevated above chest height after the surgery while resting
  • Walk for 20 minutes at least thrice a day after the surgery to prevent blood clots and promote healthy blood circulation
  • Avoid standing for a long time 
  • Do not lift heavy objects or do any strenuous activities
  • You may be allowed to start with your normal activities immediately after this procedure
• Travel:
  • Avoid driving vehicles for at least two days after the surgery
  • You may be able to resume air travel four weeks after the surgery.

When to see the doctor?

You need to notify (call or visit) your healthcare provider immediately if you are experiencing the following symptoms after this surgery:

• Sudden pain in chest 
• Difficulty in breathing 
• Fever 
• Chills
• Persistent nausea or vomiting 
• Palpitations (irregular heartbeats)
• Unbearable pain 
• Cough

The risks/complications of radiofrequency ablation vary depending on the purpose of the procedure. For example, the procedure for varicose veins may possess the following risks:

• Superficial thrombophlebitis (inflammation in the veins located below the skin surface)
• Bleeding 
• Infection 
• Nerve damage 
• Brown colouration of the skin 
• Irritation or burning sensation over the skin 
• Deep vein thrombosis (occurrence of blood clots in the deeply located veins)
• Pulmonary embolism (blockage in the arteries of the lungs)

Some of the risks of performing this procedure for BPH are as follows:

• Urinary tract infections
• Worsening of urinary symptoms
• Erectile dysfunction
• Temporarily, difficulty in urinating 
• Need for retreatment

You must revisit your surgeon within a week. During your visit, the surgeon may conduct an ultrasound scan to check for any problems. He/she may also discuss future treatment during the follow-up.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.