A novel strategy for optimizing safety and efficacy in ultrasound-guided radiofrequency ablation for secondary...

To evaluate the effectiveness and safety of an improved ultrasound-guided radiofrequency ablation (RFA) protocol for the treatment of secondary hyperparathyroidism (SHPT).

One hundred and three patients (mean age, 50.8 ± 12.8 years; 49 male) with SHPT were enrolled in this prospective trial. The participants were randomly assigned to receive either the conventional ablation protocol (n = 50) or the improved protocol (n = 53) between April 2023 and April 2024. The improved protocol included parathyroidal circumferential hydrodissection, using a short electrode, low-power settings, and intra-nodular ablation. Outcomes, including complications, clinical success rates, and the incidence of recurrent laryngeal nerve (RLN) injury, were compared between the two groups.

Hydrodissection was performed successfully in all study participants. The clinical success rate was significantly higher in the improved protocol group (94.97% vs. 89.07%, p < 0.05), together with a lower incidence of hoarseness due to RLN injury (5.7% vs. 18%, p < 0.05) compared to the conventional group. Additionally, the recovery time for hoarseness was shorter in participants who underwent the improved protocol (1.63 ± 0.92 months vs. 2.75 ± 1.37 months, p < 0.05).

The improved ablation protocol showed promising enhancements in safety and efficacy compared to conventional methods, particularly in reducing RLN injury and recovery time. Further validation is warranted before establishing it as a superior standard.