Having thermal or cryoablation

Thermal or cryoablation is a procedure to treat a tumour without surgery by burning or freezing the tumour cells.

Outpatient ablation clinic

Before having an ablation procedure, you come to our outpatient ablation clinic. You can then talk to the IR doctor about the procedure.

The IR doctor:

• reviews your notes and images from previous examinations
• explains if they recommend ablation for you
• talks to you about the benefits and risks of the procedure

You can ask the IR doctor any questions that you may have. Please tell them if you:

• need a hoist (piece of medical equipment to help lift or move you safely), transport or a translator when you have the procedure
• take any medicines regularly
• are allergic to any medicines

We need to know if you take any antiplatelet medicines (like aspirin or clopidogrel) or anticoagulant medicines (like warfarin or rivaroxaban). These are medicines that help to prevent blood clots.

You might need to stop antiplatelet or anticoagulant medicines temporarily before the procedure. If you take an anticoagulant, we might ask you to change the amount (dose) or change to another medicine temporarily. 

If you have diabetes, you might need to change the dose of your diabetes medicines. This is because you need to stop eating and drinking (fast) before the procedure.

During your appointment, the IR doctor can give you more information if you need to stop any medicines. Please ask them if you have any questions or concerns about this.

You need to have a blood test before the ablation procedure. Your IR doctor:

• explains how to arrange the blood test
• asks for details of any other medical conditions that you might have

Preparing for the procedure

On the night before your ablation procedure, you are admitted to the hospital ward. Your ward nurse then helps you to get ready for the procedure. Here are some tips to help you prepare.

An IR doctor comes to visit you, together with an IR clinical nurse specialist. They:

• review your notes
• answer any more questions
• ask you to sign a consent form giving us permission to do the procedure

Giving your permission (consent)

We want to involve you in decisions about your care and treatment. If you decide to have the ablation procedure, we will ask you to sign a consent form. This says that you understand what is involved and agree to have the treatment.

You can read more about our consent process.

During the procedure

You usually have the procedure under a general anaesthetic. This is when we give you a medicine to make you sleep during the procedure and stop you feeling any pain.

If they think that it is safe and appropriate, the anaesthetic doctor (anaesthetist) may offer you a local anaesthetic and conscious sedation instead. This involves giving you an injection of local anaesthetic medicine and 2 other medicines through a thin tube called a cannula. The medicines help to relax you and ease your pain. 

If you have a local anaesthetic and conscious sedation, you will not be asleep for the procedure. You often forget most of the procedure afterwards, but are awake enough during ablation to communicate with staff.

If we do cryoablation, you will most likely have the procedure under a general anaesthetic.

What happens during the procedure

1. We ask you to lie on the CT scan table, usually on your back, side or tummy. We monitor your blood pressure, pulse and the oxygen level in your blood.
2. If you are having radiofrequency ablation, we will attach 2 to 4 electrode pads to your legs. We do not need to use these during microwave ablation. The pads carry (conduct) the electrical current and prevent heat burns.
3. The IR doctor takes a series of CT images or ultrasound pictures. This helps them to find the best position to put in the needle (electrode).
4. The IR doctor puts in the electrode through your skin and guides it precisely into the tumour. Your skin does not need to be cut because the electrode is thin.
5. If you have thermal ablation, we will heat the tumour for about 15 minutes with radiofrequency or microwave energy. If you have cryotherapy, we will freeze the tumour for 15 to 30 minutes.
6. If you have a larger tumour, the IR doctor may need to put the electrode in another position. They can then treat a second area of the tumour in the same way.

After your treatment, the dead tumour tissue shrinks and slowly forms a scar inside your body.

As there is no surgical cut, an ablation procedure hardly affects the appearance of your skin.

How the procedure feels

If you have a local anaesthetic injection, it may sting for a few seconds. Apart from that, we aim to make your ablation procedure as free from pain as possible.

You may feel a small to medium amount of discomfort during the procedure if you are awake. A few people have a feeling (sensation) of heat if their tumour is near the inside surface of the organ being treated.

If you feel uncomfortable during the procedure, please tell the nurse. They can then give you more pain medicine.

If you have a general anaesthetic, you will be asleep throughout the procedure and not feel any pain.