Radiofrequency Energy

The Secca® procedure (Secca® System; Curon Medical Inc., Sunnyvale, CA) involves the delivery of radiofrequency energy to the lower rectum and anal canal through a specially manufactured anoscope (Figure 6-10.7). Intravenous sedation, local anesthesia, and prophylactic antibiotics are used for this outpatient procedure. The device is positioned under direct visualization at the dentate line and four needle electrodes deliver the radiofrequency energy for 90 seconds (Figure 6-10.8). Additional applications in all four quadrants are administered in 5-mm increments proximal to the dentate line for a total of 16 application sites. Recent publication of a multicenter, prospective trial reported it to be safe, minimally invasive, low risk, and effective with a significant therapeutic impact on the symptoms of fecal incontinence and quality of life.12 Procedure-specific complications were minimal and included anoderm ulcerations and bleeding. A prospective, randomized, blinded, sham-controlled trial is underway to further study the procedure. The device is not currently FDA approved except for use in clinical trials.

Figure 6-10.7. Anoscope (a) and radiofrequency (b) device of the Secca® system.The anoscope has four electrodes that deliver the radiofrequency energy (c).
Figure 6-10.8. Probe is inserted into anal canal (a). Needles are deployed and radiofrequency delivered and four to five levels of radiofrequency delivered in the four quadrants at each level (b).
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