Ablation Techniques in Medical Practice

Ablation procedures like PPDD and Coagulation are effective methods for treating various conditions such as cardiac arrhythmias, tumors, and wound debridement. RF ablation offers advantages such as precise targeting, lower tissue temperatures, and tissue preservation at the molecular level. Understanding plasma and its role in generating heat for ablation is crucial in these medical interventions.

• Ablation Techniques
• Medical Procedures
• RF Ablation
• Plasma Generation
• Tissue Preservation

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1. Jong Bum Choi, M.D. Ajou University Medical Center Department of Anesthesiology and Pain Medicine Pain Clinic

2. Method of disc decompression Based on experiences with previous products such as Chymopapain, Nucleotome Provides a safe and controlled therapy Disc decompression treatment by ablating nucleus pulposus with Low Temperature

3. PPDD PPDD vs vs Coagulation Coagulation PPDD(=Ablation) PPDD(=Ablation) 01) Definition Medical procedure in which part of the electrical conduction system of the heart, tumor or other dysfunctional tissue is ablated using the heat generated from high frequency alternating current 01) Definition Coagulation 01) Definition The volumetric or length reduction of tissue using thermal energy in a surgical procedure Coagulation 01) Definition 02) Goal Tissue shrinkage Hemostasis 02) Goal 02) Goal Removing tissue in a defined area. 02) Goal

4. application field of Ablation application field of Ablation Tumor Treat tumors in the lung, liver, kidney, and bone, as well as other body organs Tumor Cardiac arrhythmia Atrial fibrillation (AF), supraventricular tachycardia (SVT), atrial tachycardia, Multifocal Atrial Tachycardia (MAT) and some types of ventricular arrhythmia Cardiac arrhythmia Wound debridement Wound debridement D) Arthroscopy, Spine, ENT D) Arthroscopy, Spine, ENT

5. Advantages of RF ablation Intocare Advantages of RF ablation Intocare PPDD PPDD Working at lower temperatures Vs. Electrocautery generates 400~600 C tissue temperatures Working at lower temperatures (40~70 (40~70 C). C). Precise targeting Allow the surgeon to ablate the tissue in a specific area with minimal effect to the surrounding tissue. Plasma is only 100-200 m thick around the active electrode. Precise targeting Preserves tissue quality Since the tissue is dissolved of volatilized at the molecular level, and not burned or otherwise mechanically abraded. Preserves tissue quality

6. What is plasma What is plasma What is Plasma? 01) Electrode for generating plasma 01) Electrode for generating plasma 01. Ablation 65 ~80 Below 65 Electric Field 02. Coagulation 2ndelectrode 1stelectrode Insulator

7. What is plasma? What is plasma? What is Plasma? 02) How does the Plasma made? 02) How does the Plasma made? 1 1 Electric Field 2 2 vapor layer 2ndelectrode 1stelectrode Insulator 4 4 3 3

8. Intocare Intocare PPDD What is Plasma? PPDD 03) Plasma field 03) Plasma field A) The plasma field is an ionized gas consisting of free electrons, ions and excited radicals. B) In contact with biological tissue, these plasma particles are sufficiently (re)active to disintegrate organic molecular within the tissue into elementary molecules C) In this manner, the target tissue is effectively dissolved or volatilized in a gentle fashion (at low temperature) inducing no damage to surrounding healthy tissue. Figure 1. The yellow glow emitted by a INTO LB device functioning in a saline environment shows the plasma field.

9. Intocare Intocare PPDD Proven Treatment PPDD Confirmed Safety of Plasma Confirmed Safety of Plasma Molecular dissociation Molecular dissociation Histological confirmation Histological confirmation No damage Molecular dissociation by Plasma Energy No necrosis No damage on the surrounding tissue to Surrounding Tissue Decompression of herniated disc with discectomy

10. Ablation through Into Series Intocare Intocare PPDD PPDD Into LB is used for discectomy and modulation on the lumbar disc Leading to the disc decompression and removal of Into LB is used for discectomy and modulation on the lumbar disc Leading to the disc decompression and removal of nociceptor nociceptor

11. Intocare Intocare PPDD PPDD - -> Easy Access to the target lesion with no risk of disc > Easy Access to the target lesion with no risk of disc reherniation reherniation OD of the needle : 1.83mm OD of direction controllable catheter : 1.2mm OD of the needle : 1.83mm OD of direction controllable catheter : 1.2mm

12. Radicular Pain (Lateral herniation) - Arm pain - MRI evidence of contained disc protrusion - Not surgical indicated (motor weakness, etc.) - Failed Nerve Block. Axial Neck Pain (Central focal herniation) - Failed conservative therapy for 3 months - Discography positive for concordant pain - Disc height > about 75%

13. Red flag - Spinal fracture, tumor, infection - Central cord lesion Benign Lesion - 50% loss of disc height - Extruded or Sequestered disc - Moderate to Severe spinal stenosis - Complete annular disruption - Degenerative instability - Herniation greater than 1/3 the diameter of the spinal canal

14. Same as Cervical Spine basically More Ablation is needed due to large disc. Curved catheter is required. It is Technically Complicated. Clinical outcome in Cervical spine is immediate, comparing with lumbar spine.

15. Anterior approach Contralateral (or Ipsilateral) approach Between Trachea and Major vessel

16. [ Pre MRI ] [ Pre MRI ] [ Post MRI ] [ Post MRI ]

17. [ Pre [ Pre Epidurogram Epidurogram ] ] [ Post [ Post Epidurogram Epidurogram ] ]

18. [ Pre [ Pre Epidurogram Epidurogram ] ] [ Post [ Post Epidurogram Epidurogram ] ]

19. [ Pre [ Pre Epidurogram Epidurogram ] ] [ Post [ Post Epidurogram Epidurogram ] ] [ PPDD ] [ PPDD ]

20. [ Pre [ Pre Epidurogram Epidurogram ] ] [ Post [ Post Epidurogram Epidurogram ] ] [L5] [ PPDD ] [ PPDD ] [L5] [L5]

21. [ Pre MRI ] [ Pre MRI ] [ Pre MRI ] [ Pre MRI ]

22. [ Pre MRI ] [ Pre MRI ] [ Pre MRI ] [ Pre MRI ]

23. [ Pre MRI ] [ Pre MRI ] [ Pre MRI ] [ Pre MRI ]

24. [ Pre MRI ] [ Pre MRI ] [ Pre MRI ] [ Pre MRI ]

25. [ Pre MRI ] [ Pre MRI ] [ Pre MRI ] [ Pre MRI ]

26. [ Pre MRI ] [ Pre MRI ] [ Pre MRI ] [ Pre MRI ]

30. Posterior approach Contralateral or Ipsilateral approach

31. Straight type (Into-S): one way ablation Curved type, Steering type (Into-LB/CB): multi directional ablation [ Into- -LB ] [ Into For cervical / lumbar spine [ Into LB ] [ Into- -CB ] CB ] [ Into- -S ] For cervical spine [ Into S ] For cervical / lumbar spine For cervical spine

32. Safe Effective Simple Easy

33. Thank you for attention