Efficacy and safety of cooled and uncooled microwave ablation for the treatment of parathyroid adenomas.

BACKGROUND: Percutaneous microwave ablation (MWA) is an effective alternative to surgery for parathyroid adenomas, yet the clinical impact of antenna cooling mechanisms remains unstudied. AIM: To evaluate and compare the efficacy and safety of cooled versus uncooled microwave ablation (MWA) in treating parathyroid adenomas. METHODS: A retrospective analysis was conducted on 40 patients (mean age 59.1 ± 14.0 years; 67.5% female) with parathyroid adenomas treated with ultrasound-guided MWA between January 2023 and January 2024. Nineteen patients (47.5%) underwent cooled MWA, and 21 (52.5%) received uncooled MWA. Serum PTH and calcium (Ca) levels were measured at 6 months' post-procedure and compared with baseline values. RESULTS: Technical success was 100%. Both groups showed significant reductions in PTH and Ca levels over time, with no significant between-group differences. There was no procedure-related mortality or major complications. Minor complications (post-procedural pain and transient hoarseness, all resolving completely) occurred at an overall rate of 15%, with no significant difference between groups (p = 0.664). Power setting was significantly higher in the cooled group (p = 0.001), whereas intraoperative VAS pain scores were significantly higher in the uncooled group (p = 0.001). CONCLUSIONS: As the first comparative evaluation of antenna design in this domain, our findings suggest that cooled and uncooled microwave ablation were associated with substantial reductions in serum PTH and calcium levels and a low rate of minor complications. No significant differences were observed between the two techniques in laboratory outcomes or overall complication rates.