Determining a minimal safe distance to prevent thermal injury to intrahepatic bile ducts in radiofrequency ablation of the liver: A study in dogs

Purpose: To determine a minimal safe distance between the radiofrequency ablation (RFA) electrode tip and major intrahepatic bile ducts to prevent thermal injury during hepatic RFA in a canine model. Materials and methods: Forty healthy mongrel dogs were randomised equally into four groups based on the distance between the electrode and large intrahepatic bile ducts during RFA of the liver, as follows: 1.0–2.9 mm, 3.0–4.9 mm, 5.0–7.9 mm, or 8.0–10.0 mm. The RFA electrodes were opened uniformly at 2 cm. During RFA, energy was sequentially raised, starting at 5 W and increasing by 5 W increments every minute to a maximum of 95 W. Animals were monitored for a maximum of 14 days post-RFA for complications and by bilirubin testing, after which they were euthanised and their livers were surgically removed for cholangiographic and pathological examination. Results: When the electrodes were less than 5.0 mm from the bile ducts during RFA, either full or partial-thickness bile duct necrosis occurred, leading to a variety of serious complications. In contrast, when the distance was more than 5.0 mm between the RFA electrode and bile ducts, serious complications occurred rarely, with pathological examinations showing either normal bile ducts or vacuolar changes of the biliary ductal epithelium. Conclusion: A minimum safe distance of 5.0 mm between the RFA electrode and intrahepatic bile ducts was effective in preventing serious complications secondary to bile duct injury in a canine model.