RFITT in therapy of Bakers cyst – update 2

RFTT – radiofrequency in therapy of Bakers – cyst

Celon`s  RFITT is an effective option of minimal invasive therapy in Bakers cyst. We used this technique at SAPHENION first time in 2010.

Treatment of Baker’s Cysts can be either conservative or surgical. Conservative therapy includes anti – inflammatory drug therapy (ibuprofen, diclofenac) and also a puncture of the cyst.

In surgical therapy, the entire cyst is usually exposed over a fairly large incision in the popliteal fossa and prevented at its root (canal in the knee joint) and then separated. Due to the radical nature of the procedure, one must expect the usual complications of surgical intervention in sensitive regions (fossa poplitea ) after surgery.

Endocystic thermal ablation with RFITT –  catheter  is much better than the radical extirpation of cysts. Very important is the  therapy of the knee joint at about the same time.

The pictures show the cyst pre operative in situ and also in ultrasound:

saphenion-bakerzyste-prae-op saphenion-bakerzyste-prae-op1

 

 

RFITT Therapy inside the cyst.

saphenion-bakerzyste-catheter-inside

 

 

 

 

 

 

 

We treated 12 cm of cyst with 16 Watt RFITT bipolar catheter, the photo shows the catheter inside the cyst vessel. After the thermal ablation  according to the same treatment protocol of ablation veins we saw the closure of the cyst.

saphenion-bakers-cyst-after-sealing1saphenion-bakers-cyst-after-sealing2 saphenion-bakers-cyst-catheter-inside

 

 

 

 

 

Meanwhile over 100 Baker cysts treated with RFITT

After successful use in oncosurgery, urology and in the endovenous therapy of varicose veins, this results in another field of application for RFITT. Thanks to a bipolar arrangement of the electrodes, the RFITT flows a high – frequency alternating current through the cyst wall, which acts as an electrical conductor, producing a thermal effect and a tissue shrinkage (microwave effect) directly in it. So far, we have achieved permanent closure of the treated cyst in 98 cases by treatment of 109 patients (Closure rate 89.9%).

We treated 8 cysts with glue. In  5 cases we found a closure over a period of 6 month (closure rate 63%). One case showed a refill of the cyst after 6 weeks. This therapy is one possibility of endocystic catheter based treatment. We have currently not enough experiences to make a recommendation.

We treated 109 Patients with RFITT thermal ablation, 8 cases we saw a closure of the cyst about more then 6 month. (closure rate 89%). This therapy is to be recommend for the minimal invasive treatment of the Baker`s cyst. We see a lot of advantages in comparison to  radical surgery.

Todays treatment of a double Bakers cyst of the right knee joint (arthrosis 3° – Jogger, golf player)

The ultrasound one day before treatment, a medial and a lateral Baker´s cyst …Ultrasound after RFITT treatment – both cyst bodies are closed.

The left ultrasound shows the ablated medial cyst – The right ultrasound shows the lateral cyst closing by RFITT

 

 

 

 

 

 

 

Conclusions:

The endo – cystic catheter based RFITT – therapy of Baker`s cyst is an effective minimale invasive treatment option.

The sealing of cysts with VenaSeal is an other minimal invasive treatment option of the Baker`s cyst – but in relation to RFITT is the effectiveness less.

And actually we think, that the RFITT is better and the glue is not so effective for treatment of Bakers cyst. So we recommend using RFITT for this therapy.

 

Both the RFITT – thermo ablation and also the sealing are  „off label use“ – therapy! 

We have to inform our patients about this!

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