Emily A Knott1, John F Swietlik2, Katherine C Longo2, Rao F Watson3, Chelsey M Green4, E Jason Abel5, Meghan G Lubner2, J Louis Hinshaw2, Amanda R Smolock6, Zhen Xu7, Fred T Lee8, Timothy J Ziemlewicz2. 1. Department of Radiology, University of Wisconsin, 600 Highland Ave., Madison, WI 53024. Electronic address: emilyknott13@gmail.com. 2. Department of Radiology, University of Wisconsin, 600 Highland Ave., Madison, WI 53024. 3. Department of Pathology, University of Wisconsin, 600 Highland Ave., Madison, WI 53024. 4. Department of Statistics, University of Wisconsin, 600 Highland Ave., Madison, WI 53024. 5. Department of Radiology, University of Wisconsin, 600 Highland Ave., Madison, WI 53024; Department of Urology, University of Wisconsin, 600 Highland Ave., Madison, WI 53024. 6. Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania. 7. Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan. 8. Department of Radiology, University of Wisconsin, 600 Highland Ave., Madison, WI 53024; Department of Urology, University of Wisconsin, 600 Highland Ave., Madison, WI 53024; Department of Biomedical Engineering, University of Wisconsin, 600 Highland Ave., Madison, WI 53024.
Abstract
PURPOSE: To demonstrate the feasibility of Robotically Assisted Sonic Therapy (RAST)-a noninvasive and nonthermal focused ultrasound therapy based on histotripsy-for renal ablation in a live porcine model. MATERIALS AND METHODS: RAST ablations (n = 11) were performed in 7 female swine: 3 evaluated at 1 week (acute) and 4 evaluated at 4 weeks (chronic). Treatment groups were acute bilateral (3 swine, 6 ablations with immediate computed tomography [CT] and sacrifice); chronic single kidney (3 swine, 3 ablations; CT at day 0, week 1, and week 4 after treatment, followed by sacrifice); and chronic bilateral (1 swine, 2 ablations). Treatments were performed using a prototype system (VortxRx; HistoSonics, Inc) and targeted a 2.5-cm-diameter sphere in the lower pole of each kidney, intentionally including the central collecting system. RESULTS: Mean treatment time was 26.4 minutes. Ablations had a mean diameter of 2.4 ± 0.3 cm, volume of 8.5 ± 2.4 cm3, and sphericity index of 1.00. Median ablation volume decreased by 96.1% over 4 weeks. Histology demonstrated complete lysis with residual blood products inside the ablation zone. Temporary collecting system obstruction by thrombus was observed in 4/11 kidneys (2 acute and 2 chronic) and resolved by 1 week. There were no urinary leaks, main vessel thromboses, or adjacent organ injuries on imaging or necropsy. CONCLUSIONS: In this normal porcine model, renal RAST demonstrated complete histologic destruction of the target renal tissue while sparing the urothelium. Published by Elsevier Inc.
PURPOSE: To demonstrate the feasibility of Robotically Assisted Sonic Therapy (RAST)-a noninvasive and nonthermal focused ultrasound therapy based on histotripsy-for renal ablation in a live porcine model. MATERIALS AND METHODS: RAST ablations (n = 11) were performed in 7 female swine: 3 evaluated at 1 week (acute) and 4 evaluated at 4 weeks (chronic). Treatment groups were acute bilateral (3 swine, 6 ablations with immediate computed tomography [CT] and sacrifice); chronic single kidney (3 swine, 3 ablations; CT at day 0, week 1, and week 4 after treatment, followed by sacrifice); and chronic bilateral (1 swine, 2 ablations). Treatments were performed using a prototype system (VortxRx; HistoSonics, Inc) and targeted a 2.5-cm-diameter sphere in the lower pole of each kidney, intentionally including the central collecting system. RESULTS: Mean treatment time was 26.4 minutes. Ablations had a mean diameter of 2.4 ± 0.3 cm, volume of 8.5 ± 2.4 cm3, and sphericity index of 1.00. Median ablation volume decreased by 96.1% over 4 weeks. Histology demonstrated complete lysis with residual blood products inside the ablation zone. Temporary collecting system obstruction by thrombus was observed in 4/11 kidneys (2 acute and 2 chronic) and resolved by 1 week. There were no urinary leaks, main vessel thromboses, or adjacent organ injuries on imaging or necropsy. CONCLUSIONS: In this normal porcine model, renal RAST demonstrated complete histologic destruction of the target renal tissue while sparing the urothelium. Published by Elsevier Inc.
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