Resumo anatomia e fisiologia

Texto base: Radiofrequency based hyperthermia therapy: A centennial

technique serving modern surgery
Aluno: Daniel Moreira Carreira
Matrícula: 15/0122438

Resumo

The article discusses the idea that Radiofrequency currents can be used
to heat biological tissue in therapy and surgery and different examples of current
clinical applications of RF currents.
The use of heat therapy was employed in old medicine for thousands of
years to purify and to detox tissue among other things. The procedure of
cauterization for bleeding arrest was known by Hippocrates on dates before
Christ, the millennial Indian culture used heated bars to stop bleeding, but one
big problem always existed, the great amount of pain that introduced extreme
heat in contact with tissue.

In 1891 a breakthrough in tissue heating technologies occurred,

d’Arsonval figured out that high-frequency currents did not produce any kind of
nervous or muscular reaction, therefore no pain, and yet gradual heating could
be controlled. The use of metallic elements was used to close the electric circuits
through contact with the skin, these elements were electrodes. The main
discovery of it all was to find out that biological tissue could be heated with an
electric current and not only by thermal conduction. Later on, this technology
would be progressed to our current electrosurgery. Frequencies between 300kHz
and 1 MHz are called radiofrequency currents.

In order to understand how the interaction of RF currents and biological

tissue works, first, we must understand how some cells can be stimulated. If on
one hand, we have the case of electrons carrying the electric charge in metals,
on the other hand, ions are responsible for that in the biological tissue, so if we
put two metallic electrodes in contact with the tissue and apply a voltage potential,
ions would be carried towards the electrode of opposite sign. If this variation
surpass the threshold value, a series of phenomena are produced, stimulating
the cell. That is the principle behind electrosurgery and in the case of muscle
cells, it implies a mechanical contraction.

In the case of RF currents, an alternate current power supply is used in

the frequencies mentioned before. Since the alternate current is operative, the
ions on the tissue go back and forth in a very high velocity, similar to the behavior
of electrons on metals, and because of that this period is sufficiently short enough
to avoid tension across the tissue, but still produces heat through the fast motion.
That is why RF currents can produce heat without any pain.

The heating procedure occurs in a very rapid way and the tissue can be
heated up to 60°C in a few seconds depending on the applied electric power.
One of the main reasons this is targeted is because once the tissue reaches
50°C, the coagulation of the proteins of the cells happens, implying instantaneous
cellular death by coagulative necrosis. This type of coagulation is called white
coagulation.

Radiofrequency can be applied to many different uses and objectives. The

article talks about a number of those examples and to sum up, they will be divided
into topics:

 RF cardiac ablation: the main objective is the elimination of cardiac

arrhythmia, which is an electrical malfunction of a certain group of cardiac
cells. When introduced the electrical current in the tissue just under the
ablative electrode, causes a rise in temperature and therefore the
destruction of the malfunctioning cells. This procedure is used nowadays
to treat some arrhythmias that otherwise would have to undergo a more
complex and risky surgery.
 RF ablation of tumors: the other application of the RF currents are the
destruction of malign tumors. The procedure consists of an electrode
placed inside the tumor and once it reaches the center, a current is applied
until the temperature of the cells exceeds the critical temperature, around
50°C, for several minutes. How the electrode reaches, the tumor depends
on the approach of the doctors, it can be through a little incision guided by
some sort of image technique, such as ultrasound, for instance, or in a
very different approach, if the patient has already been opened, it can
easily be placed on the organ exposed.
 RF-assisted resection: consists of a device capable of producing RF
currents to reduce as much as possible the bleeding associated with the
excision of the part of an organ that contains a tumor by activating the
coagulation cell through the heating procedure mentioned before.
 Cosmetic surgery applications: the use of RF currents are being used in
the field of cosmetic surgeries as a non-invasive technique for selecting
the heating of adipose tissue by destroying the adipocytes, or cells that
contain fat. The fat tissue heats much faster than the muscle, which is a
good thing in cosmetic surgery but not desirable in procedures such as
breast cancer. When the electric field is not normal to the tissue surfaces,
the skin heats faster than the fat, being a great use to stimulate collagen
fibers that lead to firmer skin, similar to what a younger appearance should
look like
 RF thermokeratoplasty: other thermal applications of RF currents by
contracting irreversibly the collagen fibers. One example of this use is in
 cornea surgery using very small electrodes. The goal is to produce an
irreversible contraction of the corneal stroma collagen, therefore producing
a permanent change in the curvature. This procedure has been used to
treat astigmatism, keratoconus, and hyperopia.
 Sphincter reshaping by RF: this is also caused by the contraction of the
collagen fibers, in this case, to correct the sphincters. It can be used to
treat the cardiac sphincter, which connects the esophagus to the stomach,
when dealing with gastric reflux, or to treat fecal incontinence.
 Radiofrequency somnoplasty: another application of collagen contraction
is the treatment of obstructive sleep apnea, by stimulating contraction of
the tissue whose function is the obstruction, like the soft palate, to stretch
the tissue that was excessively relaxed.
 Bronchial thermoplasty: is based on ablations of the smooth muscles of
the airways, such as asthma, by targeting the capacity of structures to
constrain the frequency of asthmatic episodes can reduce considerably.
 RF-based bipolar sealing systems: this procedure uses the classical
technique of bipolar electrodes blood vessel coagulation. This technology
has experienced considerable progress resulting in homeostasis systems
adapted to specific procedures, aimed at treating hemorrhoids, the thyroid
gland, or the pancreatic tissue.
 Transurethral resection of the prostate: in this procedure electrodes have
been modified into more complex devices, also used to produce incisions
of the prostate, neck, bladder, or the resection of bladder tumors.
Transurethral needle ablation (TUNA) is the name of a new technique in
which is targeted in the ablation of the prostate in patients with benign
prostate hyperplasia.

As discussed, RF currents have many applications, nonetheless, new

technologies are being searched by focusing on three main approaches:

1. To design applicators that increase the efficacy and safety of the

conventional techniques, allowing to have surgeries as minimally invasive
as possible;
2. To achieve higher spatial accuracy by developing imaging techniques
enabling to make of thermal lesions in the right place;
3. To have systems capable of real-time information on the lesion, both its
geometry, and characteristics.
The goal among the scientists and academy is to perform surgeries with
electrodes that enable them to introduce through very small orifices and still be
very accurate. The use of nanoparticles is also being developed to have a more
circumscribed thermal effect in the case of the ablation of tumors.
 In addition, we should not forget that any advance in this technology affects
directly all sorts of surgeries and treatments currently in use meaning greater
safety and efficiency in the diverse world that is medical assistance.