Technical development of a new semispherical radiofrequency bipolar device (RONJA): ex vivo and in vivo studies

Resea ch A icle Technical De elopmen o a New Semisphe ical Radio equency Bipola De ice (RONJA): Ex Vi o and In Vi o S udies Pe Va a,1,2,3,4 Ma ek Penhake ,2Jan G epl,5Jana Ju ciko a,6Ji i Palecek,3 Michal C ha,7Jana Nowako a,2Ma in Hasal,2Ma ina Sk obanko a,3 Pe Os uszka,1Pe e Ihna ,1,3 Pa icie Delongo a,8,9 Dana Salouno a,10 Nagy A. Habib,4and Pa el Zonca1,3 1Depa men o Su ge y, Uni e si y Hospi al Os a a, 17. lis opadu 1790, 708 52 Os a a-Po uba, Czech Republic 2Depa men o Cybe ne ics and Biomedical Enginee ing, Facul y o Elec ical Enginee ing and Compu e Science, VSB-Technical Uni e si y o Os a a, 17. lis opadu 15, 708 00 Os a a-Po uba, Czech Republic 3Depa men o Su ge y, Facul y o Medicine, Uni e si y o Os a a, Syllabo a 19, 703 00 Os a a 3, Czech Republic 4Li e and Panc eas Su ge y, Hamme smi h Hospi al, Impe ial College London, Du Cane Road, London W12 0HS, UK 5Facul y o Mechanical Enginee ing, VSB-Technical Uni e si y o Os a a, 17. lis opadu 15, 708 00 Os a a-Po uba, Czech Republic 6Depa men o Vice-P esiden o Science and Resea ch, Uni e si y Hospi al Os a a, 17. lis opadu 1790, 70852Os a a-Po uba,CzechRepublic 7CEITEC VFU, Uni e si y o Ve e ina y and Pha maceu ical Sciences B no, Palack´ eho 1/3, 612 42 B no-K ´ alo o Pole, Czech Republic 8Ins i u e o Pa hology, Uni e si y Hospi al Os a a, 17. lis opadu 1790, 708 52 Os a a-Po uba, Czech Republic 9Facul y o Medicine, Uni e si y o Os a a, Syllabo a 19, 703 00 Os a a 3, Czech Republic 10Depa men o Ma hema ical Me hods in Economy, Facul y o Economics, VSB-Technical Uni e si y o Os a a, 17. lis opadu 15, 708 00 Os a a-Po uba, Czech Republic Co espondence should be add essed o Pe Va a; pe [email p o ec ed].uk Recei ed 29 Janua y 2014; Accep ed 4 Ma ch 2014; Published 9 Ap il 2014 Academic Edi o : Tsoul as Geo gios Copy igh © 2014 Pe Va a e al. This is an open access a icle dis ibu ed unde he C ea i e Commons A ibu ion License, which pe mi s un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal wo k is p ope ly ci ed. The aim o his s udy is o in o m abou he de elopmen o a new semisphe ical su gical ins umen o he bipola mul ielec ode adio equency li e abla ion. P esen ools a e uni e sal; howe e hey ha e se e al disad an ages such as abla ion o heal hy issue, nume ous needle punc u es, and, he e o e, longe ope a ing p ocedu e. Ou newly designed and es ed semisphe ical su gical ool can sol e some o hese disad an ages. By conduc ing an in i o s udy on a se o 12 pigs, andomly di ided in o wo g oups, we ha e compa ed e iciency o he newly de eloped ins umen wi h he commonly used de ice. S a is ical analysis showed ha he e we e no signi ican di e ences be ween he g oups. On a e age, he es ed ins umen RONJA had sho e abla ion ime in bo h li e lobes and educed he o al ope a ing ime. The dep h o he he mal al e a ion was on a e age 4 mm la ge using he newly es ed ins umen . The new adio equency me hod desc ibed in his s udy could be used in open li e su ge y o he ea men o small li e malignancies (up o 2 cm) in a single applica ion wi h he aim o sa ing heal hy li e pa enchyma. Fu he expe imen al s udies a e needed o con i m hese esul s be o e clinical applica ion o he me hod in he ea men o human li e malignancies. 1. In oduc ion Hepa ocellula ca cinoma (HCC) is he six h mos common cance , ep esen ing 6% o all cance s, he hi d mos com- mon cause o cance dea h, and he mos common p ima y malignancy o he li e [1]. Mos HCCs a e de eloped in pa ien s wi h isk ac o s such as ch onic hepa i is B o C and non i al li e ci hosis, which may be associa ed wi h alcoholic li e disease o nonalcoholic a y li e disease [2]. I is es ima ed ha 15–20% o colo ec al cance pa ien s p esen Hindawi Publishing Co po a ion BioMed Resea ch In e na ional Volume 2014, A icle ID 532792, 7 pages h p://dx.doi.o g/10.1155/2014/532792 2BioMed Resea ch In e na ional Elec ode needle Base hole Base Wings Pin Figu e 1: RONJA—new adio equency su gical ool. synch onous li e me as ases. Mo eo e , li e me as ases will de elopinhal o pa ien swi hcolo ec alcance in hecou se o hei disease [3]. Me as ases o colo ec al ca cinoma (CLM) and hepa ocel- lula ca cinoma (HCC) a e he mos equen indica ions o li e su ge y. Li e esec ion is he i s -line ea men op ion o pa ien s wi h p ima y and seconda y li e umo s and well- p ese ed li e unc ion. A be e li e unc ion assessmen , inc eased unde s anding o segmen al li e ana omy, using mo e accu a e imaging s udies and he echnical p og ess in su ge y a e he mos impo an ac o s ha ha e led o educed mo ali y and mo bidi y o li e umo s [4]. Radio equency ene gy has been used in medicine o mo e han one hund ed yea s and was g adually inco po a ed in o li e su ge y. Radio equency abla ion was a p omising me hod ha g adually de eloped, becoming one o he s anda d me hods o he ea men o p ima y and seconda y li e malignancies [5–8]. 2. Ma e ials and Me hods Fo c ea ing he p o o ype, a 3D model o he ins umen had o be p epa ed. The p o o ype was p oduced by 3D p in ing, which is mo e accu a e. The equipmen needed o i s p oduc ion was p o ided by he Facul y o Me allu gy and Ma e ials Enginee ing o he Technical Uni e si y Os a a. The p ac ical es was hen pe o med a he Uni e si y Hospi al Os a a using a s anda d adio equency gene a o . 2.1. RONJA De ice Desc ip ion. A new layou o elec odes con ains h ee and wo g oups o elec odes in a squa e shape posi ioned on he edges o a egula polygon. Th ee g oups o elec odes a e posi ioned on one elec ode wing and he o he wo g oups a e posi ioned on he second wing (Figu e 1). Elec ode needles on each wing bu n a semisphe ical a ea in he li e issue. The second wing bu ns an a ea be ween he bu ned a eas by he i s wing. I is necessa y o u n he ins umen by 90∘be ween each s ep and o bu n he issue in ou s eps. 2.2. RONJA De ice Design and Cons uc ion. Bo h wings and ing base o his new su gical ins umen we e c ea ed wi h he apid p o o yping echnology on dimension SST 768 di ec ly om he 3D CAD model. This machine uses FDM ( used deposi ion modeling) echnology o c ea e compo- nen sina e ysho ime omABSplas icma e ial.S ainless s eel was used o p oduce he elec ode needles (Figu e 3). The new ins umen RONJA, which has an asymme ical elec ode layou , consis s o a ing-shaped base, wo wings wi h ixed elec ode needles, and wo connec ing powe wi es. In he base ing, he e a e a numbe o holes o guide he elec ode needles in o he issue (Figu e 2). The elec ode needles wi h a qua e -ci cle shape a e bipola . The needles a e powe ed in each wing sepa a ely, be ween he inne and ou e semici cles. One pole o he RONJA ins umen is made by one semici cle o needles. Bo h wings a e connec ed o he base h ough pins in such a way ha , a e inse ion o bo h wings wi h needles in o he base, a hal -hemisphe e shape o nec o ic issue will be c ea ed a ound he umo (Figu e 4). The idea o cons uc ing his ool wi h an asymme ical layou o elec odes is comple ely new and i has no been used o hese ypes o ins umen s so a . 2.3. Ex Vi o Tes ing. Ex i o es ing ook place a he Uni e si y Hospi al Os a a on po cine li e issue because o i s simila i y o human li e . The main goal o he es ing was o unde s and whe he he new p oposed elec ode layou is sui able o su icien issuebu ningand o c ea ingasa e yzonea ound he umo (Figu e 5). Ano he goal o he s udy was o disco e any po en ial aul s and o de e mine powe le el o in i o es ing. The ins umen was connec ed o a commonly used adio equency gene a o . This gene a o is used in human medicine o su ge y wi h cu en ly a ailable ins umen s. 2.4. In Vi o Tes ing. In i o es ing was conduc ed in 2012 on a se o 12 pigs (Sus sc o a domes ica) andomly di ided in o wo g oups. The expe imen was di ided in o h ee phases. In he i s phase, heanimalsinbo hg oupsunde wen BioMed Resea ch In e na ional 3 R35,00 11,24 11,24 16,90 16,90 16,90 22,56 22,56 4,00 R17,95 14,37 11,24 6,98 4,00 4,00 4,00 27,90 31,00 31,00 27,31 24,25 19,90 19,90 D awn by G epl Jan Checked by App o ed by Da e Da e (7 h No embe 2009) Scale Radius o he needles Edi ion Page 1/1 2:1 Figu e 2: Scheme o a new elec odes layou o ou adio equency ool RONJA. Figu e 3: P o o ype o he semisphe ical ool o ex i o s udy. Figu e 4: Applica ion o RONJA de ice—ex i o expe imen . middle lapa o omy and adio equency-assis ed li e esec- ion unde gene al anes hesia. Pigs in g oup A unde wen li e esec ion using he new es ed ool RONJA and pigs Figu e 5: Resul o adio equency abla ion—semisphe ical nec o- sis o li e issue. incon olBg oupwe eope a edwi hacommonlyused ou -elec ode bipola esec ion de ice. The nex phase o he s udy ollowed 14 days a e he p ima y ope a ion and was ocused on inspec ional lapa oscopy. In he las phase, 30 days a e he i s in e en ion, all he pigs we e eu hanized and samples we e pa hologically e alua ed. The expe imen al p ojec (no. 65/2012) was app o ed by he expe commi ee on animal wel a e o he Ve e ina y and Pha maceu ical Uni e si y B no acco ding o he law on he p o ec ion o animals agains c uel y, as amended by pa ag aph 18, Ac no. 246/1992 Coll. The expe imen was app o ed by he Minis y o Educa ion, You h and Spo o he Czech Republic and was g an ed pe mission o be ca ied ou on he 7 h o Sep embe 2012. Pigs, aged one yea ,we ep o idedby heResea chIns i u eo Animal P oduc ion in Uh ine es, Depa men o Pig B eeding in 4BioMed Resea ch In e na ional Kos elec. Add ess: Komenskeho 1240, 51741, Kos elec, Czech Republic, acc edi a ion numbe 444/2011-MZE-17214, alid un il Ap il 6, 2016). All h ee phases o he in i o expe imen ook place in he esea ch ope a ing hea e o he Facul y o Ve e ina y Medicine o he Ve e ina y and Pha maceu ical Uni e si y B no. The su gical eam consis ed o wo su geons om he su gical depa men o he Uni e si y Hospi al Os a a as well as wo e e ina y su geons om he Ve e ina y and Pha maceu ical Uni e si y B no. P io o he i s su ge y, e e y pig unde wen an examina ion o i s blood coun , bio- chemis y, and hemocoagula ion. All pigs we e in amuscu- la ly p emedica ed. Anes hesia was induced by in a enously adminis e ed P opo ol (No o ol, No b ook Lab. L d., No h I eland) (0.5–1 mg/kg) and hen main ained by cons an a e in usion o P opo ol (0.1 mg/kg/min). All he ins umen s used o he middle lapa o omy we e supplied by B. B aun Medical, AESCULAP di ision. Monopola elec ocoagula- ion EMED ES 350 wi h he ou pu o 255 W was used o his pe o mance and a lapa o omy e ac o was applied. Two li e esec ions we e pe o med on each pig: one om he igh la e al lobe and one om he le la e al lobe o he li e . The li e esec ion was ca ied ou using adio equency- assis ed esec ion echnique. The subsequen li e ansec ion was pe o med using a scalpel o su gical scisso s. Minimal bleeding (no mo e han 20 mL) om he esec ion line was ea ed wi h he adio equency ins umen as well. Resec ed sampleswe e ixedin10% o malinsolu ion o subsequen his opa hological examina ion. A e inspec ion o he su - gical ield, he abdominal lapa o omy was closed in laye s. Special an isep ic sp ay, sil e aluminum ae osol and bandage p o ec ion agains con amina ion (Hen y Schein, Inc., Ge - many),wasappliedon hesu gicalwound.Thepigs,unde he con ol o a e e ina y anes hesiologis , we e eco e ed om gene al anes hesia and housed in s anda d b eeding boxes.Pos ope a i ely, heanimalswe egi enamoxicillin (15 mg/kg) and meloxicam (0.4 mg/kg) in amuscula ly. 14 days a e he li e esec ion, he second phase was execu ed o de e mine he s a us o healing o pos ope a i e complica ions in he abdominal ca i y o each animal. Fo his pu pose, a diagnos ic lapa oscopy o each pig was pe o med o assess he pos ope a i e indings. AESCULAP (B. B aun Medical., s. .o., he Czech Republic) lapa oscopy ins umen a ion was used o su ge y: a human e sion o he endoscopic ideo uni TELE PACK X and lapa oscopic op ics HOPKINS wi h he ou e diame e o 5 mm and he leng h o 290 mm (KARL STORZ Endoscopy, Ge many). The las phase o he es ing was pe o med 30 days a e he i s su ge yandau opsieso he12pigswe epe o med by a e e ina y pa hologis om he Ins i u e o Pa hological Mo phology and Pa asi ology o he Ve e ina y and Pha ma- ceu ical Uni e si y B no in he p esence o a pa hologis om heUni e si yHospi alOs a a.Slaugh e ingwasdoneby he p o ocol, lege a is. The animal ca casses we e disposed by a ende ing se ice. All animals we e opened in abdominal ca i y, hen in ho acic ca i y, ollowed by emo al o he o gans. Figu e 6: The mal came a image o he esec ion o li e pa enchyma. 2.5. S a is ical Analysis. Da a be ween he s anda d de ice g oup and RONJA g oup we e compa ed using he median es o con inuous a iables and Fishe ’s exac es o ca ego ical a iables. Da a a e p esen ed as mean ±s anda d e o o mean (S.E.M.) and median o con inuous a iables andascoun sandpe cen ages o ca ego ical a iables (complica ions). S a is ical analysis was pe o med wi h IBM SPSS so wa e e sion 18.0. A wo-sided alue o 𝑃 < 0.05was conside ed s a is ically signi ican o all analyses. 3. Resul s and Discussion 3.1. Ex Vi o Tes o he New Layou . The adio equency gene a o was se o 125 W ou pu o he i s es . Figu e 5 showsbu ned issuea e inse ionandabla ionbybo h elec ode wings. A eas we e bu ned pe ec ly e en be ween he squa e needle g oups. Wi h his con igu a ion, only wo s eps would be po en ially equi ed. Time equi ed o bu n he issuein i s es was43sec. In he second es , he adio equency gene a o was se o lowe powe ou pu , de aul 90 W. The issue was bu ned only in squa e g oups o elec odes. Fou s eps we e necessa y o c ea e a closed sa e y zone. The i s and second s eps ook 37 sec and he hi d and ou h ones 9 sec. The he mal imaging om in a ed came a showed ha he maximum empe a u e a ound 64∘C was eached in he li e issue and on needles du ing he p ocedu e (Figu e 6). Maximum empe a u e on he ins umen su ace was 33∘C, meaning ha useo hisins umen isabsolu elysa e o hesu geon. Ex i o ial helped us es ablish he powe le el o in i o es ing. 3.2. In Vi o Tes o RONJA Tool. Fo compa ison and s a is- ical e alua ion, in i o es ing da a was collec ed including esul s o blood samples, he alues eco ded du ing su ge y, and also he his opa hological e alua ion. The o e all blood analysis showed no ma ked di e ences in he obse ed alues be o e esec ion, on he 14 h day a e su ge y, o on he 30 h pos ope a i e day. Du ing li e su ge y, he o al ope a ing ime and abla ion imeo lobeswe emeasu edandcompa edinbo hg oups (Table 1). BioMed Resea ch In e na ional 5 Table 1: Ope a ing da a: he e was a signi ican di e ence (𝑃 = 0.005) in supplied powe be ween he g oups. S anda d de ice; RONJA; 𝑃 alue mean ±S.E.M. (median) mean ±S.E.M. (median) Weigh 1 (kg) 50.83 ±3.55 (47.50) 53.00 ±4.69 (55.50) 0.567 To al ope a ing ime (min) 69.00 ±6.76 (77.00) 57.50 ±3.99 (53.50) 0.567 Abla ion ime o le lobe (min) 11.67 ±2.11 (11.50) 8.83 ±1.25 (7.50) 0.567 Abla ion ime o igh lobe (min) 8.50 ±0.89 (8.00) 7.33 ±0.84 (7.00) 1 Supplied powe (W) 90.00 (unchanging) 81.67 ±1.67 (80.00) 0.005 Weigh 2 (kg) 52.92 ±3.85 (49.50) 55.17 ±4.11 (57.50) 0.567 Lapa oscopic o al ime (min) 25.33 ±5.08 (23.50) 27.17 ±4.66 (23.00) 1 Ac ual ime o lapa oscopy (min) 13.83 ±3.89 (14.00) 6.00 ±1.16 (5.00) 0.567 Weigh 3 (kg) 58.82 ±4.35 (61.00) 58.83 ±4.89 (59.90) 1 To al weigh inc emen (kg) 6.62 ±1.46 (7.00) 5.83 ±0.88 (6.65) 0.567 Li e weigh (kg) 1.54 ±0.13 (1.50) 1.48 ±0.11 (1.48) 1 Table 2: Da a conce ning complica ions: he e we e no signi ican di e ences be ween he g oups. S anda d de ice; 𝑛(%) RONJA; 𝑛(%) 𝑃 alue Complica ions du ing su ge y 0 (0) 1 (16.7) 1 Pos ope a i e complica ions 1 (16.7) 0 (0) 1 Complica ions du ing lapa oscopy 0 (0) 4 (66.7) 0.061 Pos ope a i e adhesions (li e ) 6 (100) 6 (100) — Pos ope a i e adhesions (spleen) 2 (33.3) 2 (33.3) 1 Pa hological indings—asci es 1 (16.7) 2 (33.3) 1 Pa hological indings—abscess 0 (0) 1 (16.7) 1 Pa hological indings in lungs 4 (66.7) 2 (33.3) 0.567 The es ed ins umen RONJA had sho e abla ion ime in le lobe by 2.84 minu es and 1.17 minu es in igh lobe han he commonly used de ice. The newly designed ins umen also sho ened ope a ing ime by 11.5 minu es compa ed o he s anda d de ice (Table 1). S a is ical analysis using he median es (𝑃 alue was compu ed by Fishe ’s exac es ) ailed o demons a e any signi ican di e ences be ween he wo g oups. The powe deli e y o he adio equency ene gy gene a o was op imized du ing he su gical p ocedu e. The powe supply was educed o 80 W a e obse ing i had he same e ec as he supply o 90 W. The commonly used de ice had a powe supply o 90 W. Abla ion imes we e de e mined au oma ically by he adio equency ene gy gene a o (Table 1). Only one complica ion occu ed du ing he li e su ge y (Table 2). A spleen was dese osa ed in a pig in es ed g oup A. In his animal, a se ous e usion o 250 mL was obse ed du ing pa homo phological e alua ion. The con ol lapa oscopy showed pos ope a i e adhesions in all 12 animals. No se ious pos ope a i e complica ions occu ed. Only one ad e se e en appea ed du ing an inspec ion lapa oscopy. The ans e se colon o one pig in expe imen al g oup A was inju ed when es ablishing capnope i oneum. The e we e no li e abscesses, bilia y leaks, subhepa ic abscesses, hema omas, o signs o pe i oni is in any animal o bo h g oups. Dea h o one pig in con ol g oup B occu ed in he pos ope a i e pe iod a e lapa oscopy pe o mance. An au opsy was execu ed and an acu e ca a hal-pu ulen b on- chopneumonia, onsilli is, and hini is we e de ec ed. The cause o dea h was de e mined as animal ci cula o y ailu e due o espi a o y insu iciency in he pos ope a i e pe iod in connec ion o mycoplasmal in ec ion. The abdominal ca i y a e su ge y was examined wi hou any pa hological indings. Allpigshadawellhealedsu u ewi hou anysec e- ion in he linea alba.In heabdominalca i y,a ib ous synechia was de ec ed in pa s o he esec ed li e lobes wi h pe i oneum and some adhesions we e ound be ween he li e lobes and s omach, omen um, o loops o jejunum. Resec ion ma gins in he li e lobes we e mos ly co e ed wi h ib ous issue a he adhesions. Fou emale pigs had a less se ous e usion in hei abdominal ca i ies. The ho acic ca i y in ou pigs was wi hou adhesions and e usions. The lungs o i e pigs had pa hological indings consis ing o 6BioMed Resea ch In e na ional Table 3: Da a conce ning he mal al e a ion: he e we e no signi ican di e ences be ween he g oups. S anda d de ice; RONJA; 𝑃 alue mean ±S.E.M. (median) mean ±S.E.M. (median) The mal al e a ion a he esec ion ma gin (%)— igh lobe 98.33 ±1.67 (100.00) 98.33 ±1.67 (100.00) — The mal al e a ion a he esec ion ma gin (%)—le lobe 100.00 (unchanging) 95 ±3.42 (100.00) — Maximum dep h o nec osis (mm)— igh lobe 13.00 ±1.61 (13.00) 14.83 ±2.20 (14.00) 1 Maximum dep h o nec osis (mm)—le lobe 13.67 ±1.94 (14.00) 14.00 ±0.97 (13.50) 1 Weigh o esec ed pa icle (g)— igh lobe 9.55 ±1.37 (10.20) 15.33 ±2.65 (14.40) 0.567 Weigh o esec ed pa icle (g)—le lobe 11.75 ±1.29 (11.30) 14.75 ±1.05 (14.25) 0.567 Maximum dep h o he mal al e a ion (cm)— igh lobe 1.08 ±0.08 (1.00) 1.42 ±0.07 (1.40) 0.08 Maximum dep h o he mal al e a ion (cm)—le lobe 1.08 ±0.05 (1.00) 1.45 ±0.07 (1.45) 0.08 Figu e 7: In i o s udy—ope a ing ield and condi ion o li e issue a e semisphe ical excision. a elec a ic bea ings—acu e in lamma o y o ch onic b on- chopneumonia. A ib inoid, pu ulen pe ica dial e usion was obse ed in one o hese pigs. Samples o he igh and le hepa iclobewe ecollec ed omallpigs o ahis ological examina ion. The his opa hological e alua ion o he mal changes a he esec ion ma gin showed a s ong he mal al e a ion in bo h g oups. The dep h o he he mal al e a ion was on a e age 4 mm la ge in g oup A using he newly es ed ins umen ; dispe sion o alues was 12–17 mm. S a is ical analysis using he median es (𝑃 alue was compu ed by Fishe ’s exac es ) did no show any signi ican di e ences be ween he g oups (Table 3). The s a is ical analysis showed ha he e we e no any di e ences be ween he es ed g oup A and he s anda d g oup B. 4. Discussion Ou ex i o and in i o expe imen al s udies demons a ed he easibili y and sa e y o he newly de eloped semisphe ical bipola de ice RONJA o he li e abla ion and esec ion. The e we e no s a is ically signi ican di e ences be ween he new es ed de ice and he gene ally used mul iple needle de ice. A sphe ical a ea o coagula ed nec osis was achie ed in all cases using he new semisphe ical adio equency de ice RONJA (Figu e 7). The main ad an ages o he RONJA de ice agains he commonly used mul iple needle de ice include educ ion Figu e 8: Mic oscopic sec ion o li e biopsy, he mal al e a ion o hepa ic issue, pe i asal edema, and cen al eins dila a ion. o needle punc u es in o li e issue, as e abla ion ime, and, he e o e, educ ion o o al ope a ing ime and o possibili y o epea ed esec ions in case o me as a ic elapse o p og ession o he disease because o a be e p ese a ion o he heal hy li e issue. Manyau ho sha eusedapo cinemodelin easibili yand sa e y s udies o de ices o adio equency abla ion. W igh e al. compa ed adio equency and mic owa e abla ion on he g oup o nine een pigs [9]. They concluded ha mic owa e and adio equency abla ion zones a e simila in pa hologic appea ance and imaging cha ac e is ics. Using ou RONJA de ice, we also ha e no obse ed any di e ence in he his opa hological e alua ion o he abla ion (Figu e 8). Va ada ajulu e al. (2009) pe o med RFA o po cine li e using he e ac able umb ella-shaped elec ode a ay wi h e ec i e coagula ion nec osis o la ge a eas [10]. Lee e al. (2013) con i med ha RFA p ocedu es using 15-G Oc opus elec odes a e use ul and sa e o c ea ing a la ge abla ion o po cine li e in a single elec ode model as well as in he mul iple elec odes model [11]. Schu e al. used a po cine model wi h he aim o es ing a new de ice consis ing o a linea a ay o blade-shaped 1 cm wide adio equency (RF) elec odes 1.5 cm apa . A o al o 7 li e lobes we e esec ed om 2 domes ic swine in his s udy. The au ho s de eloped a de ice ha apidly coagula ed he hepa ic esec ion plane in an animal model. In he au ho s’ opinion he new de ice shows p omise in he e o o educe blood loss and ope a ing ime du ing li e and kidney esec ions [12]. BioMed Resea ch In e na ional 7 5. Conclusion We ha e designed and de eloped a new semisphe ical bipola adio equency de ice ha apidly coagula es he hepa ic esec ion plane in a po cine model. Ou p o o ype was able o coagula e he semisphe ical con ou o li e pa enchyma wi h success ul coagula ion o all blood essels. This de ice shows p omise in e o s o educe heal hy li e pa enchyma esec ion du ing li e su ge y in a po cine model. By pe - o ming esec ion o pig li e pa enchyma using he new semisphe ical de ice, we ha e con i med ha his new me hodise ec i eandsa e.Thede icecouldbeusedin he ea men o small malignancies (up o 2 cm in diame e ) in pe iphe al pa s o li e lobes. Howe e , i is no sui able o esec ions in he a ea o hepa ic hilus. Fu u e animal and clinical s udies will need o e alua e semisphe ical li e RF esec ion wi h espec o he local ecu ence o hepa ic umo s. Con lic o In e es s The au ho s decla e ha he e is no con lic o in e es s ega ding he publica ion o his pape . Acknowledgmen s This wo k was suppo ed by MH CZ-DRO-FNOs/2012, MH CZ-DRO-FNOs/2013, and SGS VSB-TUO, G an no. SP2013/116, and by he P ojec “CEITEC—Cen al Eu o- pean Ins i u e o Technology” (CZ.1.05/1.1.00/02.0068) om he Eu opean Regional De elopmen Fund. The wo k and he con ibu ions we e suppo ed by he P ojec SP2013/35 “Biomedical enginee ing sys ems IX” and TACR TA01010632 “SCADA sys em o con ol and measu emen o p ocess in eal ime.” The pape has been elabo a ed in he amewo k o he IT4 Inno a ions Cen e o Excellence P ojec , Reg. no. CZ.1.05/1.1.00/02.0070, suppo ed by he Ope a ional P og amme “Resea ch and De elopmen o Inno a ions” unded by S uc u al Funds o he Eu opean Union and s a e budge o he Czech Republic. Re e ences [1] J. Fe lay, H.-R. Shin, F. B ay, D. Fo man, C. Ma he s, and D. M. Pa kin, “Es ima es o wo ldwide bu den o cance in 2008: GLOBOCAN 2008,” In e na ional Jou nal o Cance , ol.127,no. 12, pp. 2893–2917, 2010. 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Choi, “E alua ion o he in i o e iciency and sa e y o hepa ic adio equency abla ion using a 15-G Oc opus in pig li e ,” Ko ean Jou nal o Radiology, ol.14,no.2,pp.194–201,2013. [12]D.J.Schu ,A.P.O’Rou ke,J.A.Will,J.G.Webs e ,D.M. Mah i, and D. Haemme ich, “An elec ode a ay ha minimizes blood loss o adio equency-assis ed hepa ic esec ion,” Med- ical Enginee ing and Physics, ol.30,no.4,pp.454–459,2008. 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