Article
Evolving Practices: Microwave Ablation with Multiple Probes & Ablation Confirmation Software
Ronak Patel • Updated Jun 20, 2023
Microwave ablation is becoming a standard of practice procedure in liver and lung ablations, as we are slowly shifting away from other techniques like cryotherapy. Along with the speed and efficiency associated with microwave ablation, the introduction of NeuWave’s ablation confirmation software significantly modifies the procedure landscape, allowing the safe use of multi-probe techniques and larger ablation zones. Throughout this article, Dr. Josh Kuban, a seasoned interventional radiologist, discusses his initial experience with ablation procedures and his incorporation of NeuWave into his practice.
The BackTable Brief
• While Dr. Kuban primarily utilizes NeuWave and microwave techniques for liver ablations, lung ablations are predominantly performed with cryotherapy. However, an increasing preference towards microwave for lung ablations is evident due to its efficiency and speed in treating smaller nodules.
• Ablation confirmation software has allowed operators to use multiple probes covering larger and faster ablation zones as well as to be more aggressive in coverage at the outset of procedures. With the integration of ablation confirmation software into his workflow, Dr. Kuban has seen a tremendous impact on his practice and encourages his peers to improve their proficiency with it.
Table of Contents
Adopting Microwave Ablation
Advantages of Multi-Probe Ablation & Confirmation Software in Liver Ablation
Adopting Microwave Ablation
Dr. Josh Kuban highlights the landscape of his practice, which features a fusion of vascular and ablation procedures. With his journey commenced with a predominant focus on vascular procedures, a gradual focus into the realm of ablation was prompted by forming relationships with an assortment of oncologists and gastroenterologists. At the time of writing this, Dr. Kuban administers roughly four liver ablations per week, signifying an equal split between vascular and ablation procedures in his practice. Furthermore, he underscores the essential role that established relationships with providers play in the overall structure of the profession. In terms of technology utilization, while Dr. Kuban leans heavily towards NeuWave and microwave for liver ablation, his lung ablations predominantly employ cryotherapy, with a slow but increasing shift towards microwave ablation technology due to its speed and efficiency in treating small lung nodules.
[Dr. Christopher Beck]:
Now let's talk about your current practice. This may seem like a silly question. You're not exclusively doing ablations? You handle the full breadth of IR procedures, and you just happen to do a lot of liver and lung ablation?
[Dr. Josh Kuban]:
Yeah, I mean how it started, I actually didn't start by doing a lot of ablation. I was mostly doing vascular because that's what I trained on.
[Dr. Christopher Beck]:
Sure.
[Dr. Josh Kuban]:
Through my relationships with, I got in with a group of oncologists, the GI folks, and so I just started doing their cases and learning whatever they needed, so it's not-- I definitely don't just do ablation. I probably do, I don't know, four, or so, liver ablations a week, something around that. I do three days of cases a week, and so it's mixed. Half my cases are ablation, and half are vascular-based. Okay. It's definitely not. There are areas in our practice where people really focus on certain things, and it makes sense because you have-- Like my buddy, Rahul, he has a great relationship with the GU medical oncologists, and that's a really great way to do it because you can do all the things that that group needs. If you can't, you can learn it from one of your partners.
It's all based on relationships, whether it's a biopsy, whether it's a thrombectomy, whether it's an ablation, it's all based on these relationships with these providers. That's how our section is structured.
[Dr. Christopher Beck]:
Nice. Liver and lung, NeuWave or microwave exclusively?
[Dr. Josh Kuban]:
No, for liver, microwave exclusively. I haven't done a liver cryo, except for maybe some extrahepatic nodules that are right next to the liver.
[Dr. Christopher Beck]:
Sure.
[Dr. Josh Kuban]:
I've done some cryo for those, but really almost exclusively NeuWave and microwave. In the long, I'm mostly cryo, actually. I'm getting more and more experience with microwave, but there's a pretty thin strip of places where I feel really comfortable with microwave, right now, smaller lesions in the center, but not too central, but not too peripheral.
[Dr. Christopher Beck]:
Sure.
[Dr. Josh Kuban]:
I'd say maybe like 20% microwave, but that number is definitely changing over time as I get more experience with it. It's great how fast it is compared to cryo. Doing long triple freeze and doing a microwave. It's just a really efficient way to treat a small lung nodule.
Listen to the Full Podcast
Episode # 257 • 31 Oct 2022
Microwave Ablation for Liver Lesions
In this episode, Dr. Chris Beck interviews Interventional Radiologist Dr. Josh Kuban about his liver tumor ablation practice at MD Anderson Cancer Center, including how it's evolved over time with newer technologies. They also discuss patient workup for liver tumors, treatment with microwave ablation, and post-procedure follow up. Dr. Kuban shares why he uses microwave ablation technology, and the advantages of ablation confirmation software for these procedures.
This podcast is supported by
Advantages of Multi-Probe Ablation & Confirmation Software in Liver Ablation
Dr. Josh Kuban highlights the factors that contribute to his preference for utilizing NeuWave microwave ablation in his practice. His familiarity with the device, owing to his training, and its higher power compared to other alternatives initially guided him toward NeuWave. Further piquing his interest was the introduction of the ablation confirmation software, which significantly changed his practice. The ability to employ multiple probes, even for relatively small lesions, has been instrumental in enabling larger ablation zones and faster procedures. Kuban rarely performs a single probe ablation, preferring to use two probes or one probe with a redirect for lesions larger than a centimeter. This technique, influenced by the adoption of ablation confirmation, ensures more aggressive coverage at the initial stage, enhancing the efficacy of his procedures.
[Dr. Christopher Beck]:
Why NeuWave?
[Dr. Josh Kuban]:
NeuWave I think was probably what I was most familiar with coming out of training, and Damien was an early adopter, so I learned from him. I learned my times and my wattages based on that. Then from there, it was the best device available to me, a little bit higher power compared with RF or some of the other microwave devices. Then once they started rolling out the ablation confirmation, it made things a really different for me. It was really nice. I like being able to use multiple probes, using three probes or two probes.
It's very rare that I do a single probe ablation, even for pretty small lesions now. I like the idea of using multiple probes. I like the ablation confirmation software. I'm sure we'll get into that a little bit more, but those are two huge things that have made a big difference for me choosing them. I'm not exclusive to them. I definitely have used other systems. We have other systems available, but it's just much more comfortable for me. It's much more efficient. I can get what I need to do, larger ablation zones, and faster. All of those things have made it preferable for me.
[Dr. Christopher Beck]:
You actually touched on one thing that I wanted to drill down on. You said it's rare for you to use a single probe, so you're almost always-- even if it's a smaller lesion, like a one-centimeter or two-centimeter lesion, you bracket and then ablate by just posting it on both ends of the tumor?
[Dr. Josh Kuban]:
Yes. I think that probably started changing when I started doing AC more because I started realizing how my single prob ablations are really just not as big as you'd like them to be. You do one for like-- Really, now, if it's like seven millimeters, okay, I can get it perfect, I'll do it. Anything over a centimeter, I'd rather just bracket it or, at least, do a redirect. That came because when I first started using AC and then I'd go back and then I'd have to go back in and start re-ablating, and that adds more time, et cetera. It's allowed me to change my practice to be a little bit more aggressive at the front end, in terms of coverage, and most time that means two probes. I think that's better in a lot of ways or a one probe with a redirect. Those are the most common thing ways I do ablation.
[Dr. Christopher Beck]:
You use an acronym, AC, what does that mean for you? Ablation confirmation?
[Dr. Josh Kuban]:
Oh, ablation. Yes, I think it's ablation confirmation software for NeuWave. They're not the only people that make it, but ablation confirmation was something that wasn't around when I was in training, at all, and I've really gotten into it in the past year, year and a half. I was like, "Oh." It was my aha moment. It was a real eye-opener to know that this technology makes a big difference. If I didn't have that, I would have left lesion there. That was an eye-opener for me, and since then, I've really gone head first and tried to improve it, embrace it, get faster with it, and really try to learn a lot more of the evidence behind it as well.
Dr. Josh Kuban is presenting on behalf of Ethicon. The presentation reflects the opinions of the individual presenter, and the steps described may not encompass the complete steps of the procedure. Additionally, other surgeons may prefer different techniques, approaches, etc., as individual surgeon experience in his/her clinical practice, as well as patient needs, may dictate variation in procedure steps. Accordingly, results from any case studies reported in this presentation may not be predictive of results in other cases.
Before using any medical device, review all labeling, including without limitation; the Instructions For Use (IFU), and relevant package inserts with particular attention to indications, contradindications, warnings and precautions, and steps for use of the device(s).
This presentation is not accredited for CE/CME.
Dr. Josh Kuban is compensated by and presenting on behalf of Ethicon and must present information in accordance with applicable regulatory requirements.
The NeuWave™ Ablation System and Accessories are indicated for the ablation (coagulation) of soft tissue in percutaneous, open surgical and in conjunction with laparoscopic surgical settings, including the partial or complete ablation of non-resectable liver tumors. The NeuWave™ Microwave Ablation System and Accessories are not indicated for use in cardiac procedures. The system is designed for facility use and should only be used under the orders of a clinician.
The Materials available on BackTable are provided for informational and educational purposes only and are not a substitute for the independent professional judgment of a qualified healthcare professional in diagnosing or treating patients. Any opinions, statements, or views expressed are those of the individual contributors and do not necessarily reflect those of the publisher, platform, or any affiliated organization.