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Published on: November 4, 2022
Pilot Study: Endoscopic-assisted Plasma Radiofrequency Ablation: A Minimally Invasive Strategy for Extremity
Ren Cai1, Xiangyi Wu2, Yifeng Han1
1From the Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Background:
Lymphatic malformations (LMs) of the extremities present a therapeutic challenge due to their diffuse infiltration of subcutaneous and deep fascial compartments, often complicated by previous treatment failures and high recurrence rates.
Methods:
We conducted a pilot study to evaluate the feasibility and safety of a novel minimally invasive technique, endoscopic-assisted plasma radiofrequency ablation (EPRA), in managing complex extremity LMs. Between November 2024 and April 2025, 5 patients with recurrent, multilayered LMs involving the thigh, knee, or calf underwent EPRA under general anesthesia. Magnetic resonance imaging and multidisciplinary evaluation confirmed preoperative diagnosis and lesion mapping. The procedure used small incisions for endoscopic access, continuous saline irrigation for hydrodissection, and bipolar radiofrequency ablation to selectively coagulate aberrant lymphatic vessels under direct visualization.
Results:
All cases were completed without conversion to open surgery, with a mean operative time of 60 minutes. No major complications were observed, and transient postoperative edema resolved spontaneously within 1 week. At short-term follow-up, patients demonstrated functional preservation and satisfactory cosmetic outcomes, with no evidence of early recurrence.
Conclusions:
The EPRA technique offers a promising therapeutic alternative that combines the precision of endoscopy with the targeted energy delivery of radiofrequency ablation, thereby minimizing collateral damage and reducing the risks associated with conventional sclerotherapy or open resection. This initial experience supports the feasibility and safety of EPRA for extremity LMs, particularly in anatomically complex or treatment-refractory cases, and provides a foundation for future studies with expanded patient cohorts and long-term outcomes.
