Ideally, we would like to perform the procedure early in the day so that there is adequate time for the patient to be monitored and observed in the Radiology Recovery Room. If the patient is feeling well, he/she will then be discharged from the hospital on the day of the procedure. However, if the patient lives far away we recommend that he/she stay in town and make overnight accommodations. If there are no problems overnight, the patient may return home the next morning.
If the procedure is not performed until the afternoon, there may not be adequate time for recovery in Radiology, in which case an overnight hospital stay (referred to as a 23 hour admission) may be necessary. If there are no overnight complications, the patient will be discharged the next morning.
All patients must have a driver with them who is required to stay at the hospital during the procedure; patients are not permitted to drive less than 24 hours following the procedure.
Radiofrequency, Microwave, and Cryoablation can be painful procedures. In the majority of cases,“moderate sedation” is the best choice for the control of both anxiety and pain. With this technique, a combination of sedative and pain medications, typically Versed, Fentanyl and occasionally Dilaudid, are used and are administered intravenously. With moderate sedation, patients are usually very drowsy
but not entirely asleep. For example, during the procedure you will be able to respond to basic commands such as “take in a deep breath and hold it” but you may not remember the procedure afterwards. Some patients may have allergies to the medications given during the procedure, so remember to describe all known drug allergies and any prior adverse reactions to the doctor and nurse before the procedure.
For the first 12 hours after the procedure many patients experience only mild pain requiring an occasional pain tablet by mouth. Percocet is a common medication used for pain control following ablation. A few patients may also experience nausea or vomiting as a result of the medications used during the procedure, which can be controlled with an antinausea medication.
Patients with larger tumors may experience a “post infarction syndrome” which is associated with a low grade fever (less than 101°F), nausea, and/or achy flu-like symptoms. These symptoms are not associated with an infection and are treated with Tylenol, and they usually subside within 12 to 24 hours. Also, in rare instances, a patient may experience prolonged pain greater than one week, in which they should contact their doctor.
Imaging follow up protocols can vary based upon the type of tumor. In general, we would like you to have a follow-up CT scan 1-3 months after the procedure with and without contrast. What we find during that scan will determine how often a follow-up CT will be needed thereafter. In some patients, an MRI with intravenous contrast material is an acceptable alternative. Occasionally, a PET scan is performed to help interpret the CT or MRI findings. We would prefer that you have your imaging at Duke University Medical Center primarily because techniques vary widely from institution-to-institution.
Some lesions, particularly those that are larger, will require more than one treatment session to destroy the entire tumor. In some patients, additional lesions will arise at a later date and these may also be treated. In general, as long as we can see the lesion with CT or US and are able to navigate the probe into the lesion, we can treat you as many times as necessary.