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| title | chunk | source | category | tags | date_saved | instance |
|---|---|---|---|---|---|---|
| Radiofrequency ablation | 2/3 | https://en.wikipedia.org/wiki/Radiofrequency_ablation | reference | science, encyclopedia | 2026-05-05T07:32:26.338818+00:00 | kb-cron |
== Aesthetics dermatology == Radiofrequency ablation is also used in dermatosurgical applications in the form of electrosurgery. Depending on the output waveform used, different modes of ablation can be achieved, including are electrosection (cutting), electrocoagulation, electrodessication and fulguration. The use of radiofrequency ablation has obtained importance as it can be used to treat most of the skin lesions with minimal side effects and complications.
== Varicose veins == Radiofrequency ablation is a minimally invasive procedure used in the treatment of varicose veins. It is an alternative to the traditional stripping operation. Under ultrasound guidance, a radiofrequency catheter is inserted into the abnormal vein and the vessel treated with radio-energy, resulting in closure of the involved vein. Radiofrequency ablation is used to treat the great saphenous vein, the small saphenous vein, and the perforator veins. The latter are connecting veins that transport blood from the superficial veins to the deep veins. Branch varicose veins are then usually treated with other minimally invasive procedures, such as ambulatory phlebectomy, sclerotherapy, or foam sclerotherapy. Currently, the VNUS ClosureRFS stylet is the only device specifically cleared by FDA for endovenous ablation of perforator veins. The possibility of skin burn during the procedure is very small, because the large volumes (500 cc) of dilute Lidocaine (0.1%) tumescent anesthesia injected along the entire vein prior to the application of radiofrequency provide a heat sink that absorbs the heat created by the device. Early studies have shown a high success rate with low rates of complications.
== Obstructive sleep apnea ==
RFA was first studied in obstructive sleep apnea (OSA) in a pig model. RFA has been recognized as a somnoplasty treatment option in selected situations by the American Academy of Otolaryngology but was not endorsed for general use in the American College of Physicians guidelines. The clinical application of RFA in obstructive sleep apnea is reviewed in that main article, including controversies and potential advantages in selected medical situations. Unlike other electrosurgical devices, RFA allows very specific treatment targeting of the desired tissue with a precise line of demarcation that avoids collateral damage, which is crucial in the head and neck region due to its high density of major nerves and blood vessels. RFA also does not require high temperatures. However, overheating from misapplication of RFA can cause harmful effects such as coagulation on the surface of the electrode, boiling within tissue that can leave "a gaping hole", tears, or even charring.
== Pain management ==
=== Back === RFA, or rhizotomy, was developed by Nikolai Bogduk to treat chronic pain arising from the facet joints in the lower (lumbar) back. Radiofrequency waves are used to produce heat on specifically identified nerves surrounding the facet joints called the lumbar medial branches of the dorsal ramus of the spinal nerves. By generating heat around the nerve, the nerve is ablated, thus destroying its ability to transmit signals to the brain. The nerves to be ablated are identified through injections of local anesthesia (such as lidocaine) around the medial branches prior to the RFA procedure to first confirm the diagnosis. If the local anesthesia injections provide temporary pain relief, the injection is repeated a second time to confirm the diagnosis. Then RFA is performed on the nerve(s) that responded well to the injections. RFA is a minimally invasive procedure which can usually be done in day-surgery clinics, going home shortly after completion of the procedure. The person is awake during the procedure, so risks associated with general anesthesia are avoided. Whether for back or knee pain, a drawback for this procedure is that nerves recover function over time, so the pain relief achieved lasts only temporarily (3–15 months) in most people.
=== Knees ===
Radiofrequency ablation of sensory nerves in the knee, also called genicular neurotomy or genicular RFA, is clinically preceded by confirming pain reduction upon anesthetizing the main knee sensory nerves in a test procedure called genicular nerve block. Genicular nerve block is a short (10–30 minutes), outpatient procedure usually performed weeks before genicular RFA. The extent of pain reduction by injecting a local anesthetic, such as bupivacaine, at specific locations of the target genicular nerves, is self-assessed by the person for hours after the procedure, leading to confirmation with the physician of the need for RFA. In the procedure for genicular RFA, a guide cannula is first directed under local anesthesia and imaging (ultrasound or fluoroscopy) to each target genicular nerve, then the radiofrequency electrode is passed through the cannula, and the electrode tip is heated to about 80 °C (176 °F) for one minute to cauterize a small segment of the nerve. The heat destroys that segment of the nerve, which is prevented from sending pain signals to the brain. As of 2019, several hundred publications showed promise for substantial, long-term (6 months or longer) reduction of knee pain following genicular RFA. The US Food and Drug Administration had approved in 2017 a commercial device using cooled RFA, with effects lasting for up to a year of pain relief from knee arthritis. As of 2023, reviews of clinical outcomes indicated that efficacy for reducing knee pain was achieved by ablating three or more branches of the genicular nerve (one of the articular branches of the tibial nerve). Other sources indicate 4-5 genicular nerve targets may be justified for ablation to optimize pain relief, while a 2022 analysis indicated that as many as 10 genicular nerve targets for RFA would produce better long-term relief of knee pain. Knee pain relief of 50% or more following genicular RFA may last from several months to two years, and can be repeated by the same outpatient procedure when pain recurs. An anatomical study of cadaver knees indicated that ultrasound-guided bony landmarks could be used to effectively target the superior medial geniculate nerve, superior lateral geniculate nerve, and inferior medial geniculate nerve – the three nerves commonly targeted for knee RFA – with average nerve-to-needle distances of 1.7, 3.2, and 1.8 mm, respectively.