良性甲状腺結節に対するラジオ波焼灼療法：内分泌外科ユニットの初期成績

Introduction Radiofrequency ablation (RFA) is a minimally invasive alternative for the management of benign thyroid nodules in patients with symptomatic or enlarging lesions who seek to avoid the risks and morbidity associated with surgery. Our aim was to evaluate the initial RFA results of our endocrine surgery unit. Methods We analyzed our early RFA outcomes from November 2022 to November 2024. The VIVA RF system (STARmed Co. Ltd., Goyang-si, GG, KOR) was used, with an internally cooled 18-gauge electrode and a 10-mm active tip. The ultrasound (US)-guided trans-isthmic approach and the moving-shot technique were used in all patients after two confirmed Bethesda II cytologies. Results We identified 33 cases, mostly women (93.9%), with a mean age of 54 years old. Surgical indications were restricted to compressive symptoms (19/33, 57.6%), cosmesis (4/33, 12.1%), or both (10/33, 30.3%). The nodules were classified per the European Thyroid Imaging and Reporting Data System (EU-TIRADS): category 2 (2/33, 6.1%), category 3 (25/33, 75.8%), and category 4 (6/33, 19.2%). The average nodule volume was 12 mL. The mean energy delivered and duration were 16150 J (± 10836) and 7.2 min (± 4.3), respectively. We report three cases (9.0%) of postoperative morbidity: a subcutaneous hematoma, a Horner syndrome, and a patient with transient hoarseness. At three months, the mean volume reduction ratio (VRR) was 40.4%, while the six-month VRR was 47.1%. Conclusion Our initial experience demonstrated a near 50% volume reduction at six months. The RFA's low complication rate, coupled with the freedom to perform the procedure with local anesthesia, makes it an attractive option. Regrowth and the need for reintervention are possible. Further follow-up is necessary to assess long-term efficacy and recurrence.