Ultrasound-guided minimally-invasive RFA surgery takes place in a surgical room. Benign thyroid nodules, goiter, hyperfunctioning nodules (toxic adenomas), non-metastatic malignant micro-papillary tumors (<1cm), lymphatic metastases that cannot be treated surgically or with radioiodine can be treated by means of an innovative approach, which complement open surgery. RFA uses radiofrequency waves generated by a special needle-electrode, which generate elevation of the localized temperature inside the nodule, destroying it. The intervention takes place by introducing a radiofrequency (RF) needle-electrode into the nodule under ultrasound assistance, which, thanks to an internal cooling system, produces thermal elevation at the tip while maintaining a non-harmful temperature along the rest of the needle in contact with other healthy structures of the neck. The most used technique is monopolar radiofrequency. During the surgery, the patient is part of a circuit that includes a radiofrequency generator, a needle-electrode and two dispersion plates positioned on the patient's legs. Local pericapsular thyroid anesthesia and sedation with midazolam and propofol are performed under monitoring of vital parameters and the assistance of an anesthetist / resuscitator. The patient does not feel any discomfort during the procedure. Intubation is not necessary. In the weeks and months following RF ablation, a progressive volumetric reduction of the treated nodule will be obtained, with a consequent reduction in compression symptoms and visible swelling. Remarkable is the improvement in the quality of life. The reduction is on average 80% compared to the initial volume but can vary according to the type of ablated tissue, the conformation and the size of the nodule. The treatment can be repeated after some time if necessary. Initially thyroid nodule ablation was performed through the laser. However the laser can obtain an average of 45-50% volume reduction rate of the nodule. The administration of analgesics (paracetamol) and corticosteroids (methylprednisolone) effectively prevents local pain and discomfort after the procedure. In very rare cases, the operation can cause dysphonia (hoarseness due to paralysis of a vocal cord) due to overheating of the recurrent laryngeal nerve, which is transient in almost all cases. In the outpatient context in which the intervention is carried out, all the necessary tools are available to deal with any side effects described. Thermoablation treatment of thyroid nodules using RFA represents a cutting-edge therapeutic alternative to a traditional surgical solution or radioactive iodine therapy. The advantages of ultrasound-guided radiofrequency over traditional “open” surgery are: absence of scars, organ preservation and normal function of the thyroid, no need to take any therapy, minimal side effects, and absence of general anesthesia, drainage tubes, hospitalization, much faster recovery, minimized aggression, and improvement of the quality of life.

The objective of the study was to assess endoscopic coblation adenoidectomy and conventional cold curettage adenoidectomy in terms of safety and efficacy in pediatric patients. Study included 40 pediatric patients, aged between 4–17 years. 20 patients underwent cold curettage adenoidectomy and 20 underwent Coblation adenoidectomy. The 2 procedures were compared on various parameters like duration of surgery, intra—operative blood loss, and post –operative pain. To further the comparison, follow -up Nasal Endoscopy was done after 1 week and after 1 month to assess for injury to peripheral tissues and completeness of removal of adenoids. There was statistically significant difference, favouring Coblation adenoidectomy in terms of lesser intra-operative blood loss (mean blood loss of 19 mL Vs 28.5 mL) and lesser post operative pain measured on Visual Analogue Scale (median VAS score of 2 Vs 2.67). Shorter duration of surgery (mean operative time of 10.3 min Vs 15.5 min) was the only parameter in favour of conventional cold curettage method. Injury to peripheral tissue and residual adenoid were seen in patients who underwent curettage adenoidectomy. The overall advantages of Coblation adenoidectomy when compared with cold curettage adenoidectomy are less intra-operative bleeding, less post operative pain, completeness and preciseness of adenoid removal with minimal injury to adjacent tissues. For these reasons, Coblation adenoidectomy should be the standard technique adopted for adenoidectomy.