Since 2019, TATO uncooled microwave (MW) ablation system has been adopted in Europe to treat symptomatic benign thyroid nodules (BTN).
Several centers have reported and published positive safety and efficacy results.
PUBLICATIONS AND MAIN RESULTS
Uncooled microwave ablation as a treatment option to preserve thyroid function in patients with benign thyroid nodules" by Gulsah Yildirim et al.
In this publication Dr. Gulsah Yildirim and Hakki Muammer Karakas, at Istanbul Fatih Sultan Mehmet Training and Research Hospital in Turkey, highlighted the safety, feasibility, performance of this system, following up the first 40 patients, without major complications.
Antibody levels and thyroid function tests have remained within normal limits with no significant change during follow-ups. Symptoms and cosmetic scores were significantly improved at all follow-up, obtaining notable volume reductions of the nodules.
Artery-first microwave ablation in the treatment of benign thyroid nodules" by Gulsah Yildirim et al.
In this publication Dr. Yildirim et al. confirmed the previous results and investigated successfully the option to improve the ablation in highly vascularized nodules by treating the arterial feeder ("Artery first" approach), to obtain a good hemostasis. Notably this approach showed an increased volume reduction at 3 and 6 months compared to the control group.
Dr. Dionisio et al. initial-experience-of-microwave-ablation-for-benign-and-malignant-thyroid-nodules-our-short-term-results, CIRSE 2022 poster
In her initial experience, Dr. Dionisio reports similar results to previous publications in terms of safety and effectiveness of the procedure, with follow ups at 1, 6 and 12 months:
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1 month FU - #5 pts – Volume reduction from 11,3 cc to about 7,00 cc
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6 months FU - #12 pts – Volume reduction from13,0 cc to around 2,0 cc
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12 months FU - #2 pts – Volume reduction from 11,2 cc to 0,41 cc
Conclusions: >60% VRR after 6 months, > 80% VRR after 12 months. Disappearance of compressive and cosmetic symptoms of 80% after 1 month and 90% after 6 months. Moreover, she also reported the treatment of two malignant nodules: CT scan at 4 months showed tumor disappearance and absence of locoregional or distant disease progression in both patients.
Multiple overlapping microwave ablation in benign thyroid nodule: a single-center 24-month study" by Eduardo Crespo Vallejo et al.
A novel publication on December 2022, from a single center study conducted by Eduardo Crespo et al. at Hospital Universitario Fundacion Jiménez Diaz, in Madrid, Spain, further consolidated the evidence on safety, performance and clinical outcomes, with a solid follow up of 24 months on 30 patients.
Microwave ablation for large benign thyroid nodules: a proposal for a new approach: the fluid-motion technique" by Camillo Aliberti et al.
On October 2023, Dr. Aliberti and Dr. Casaril from Pederzoli Hospital in Peschiera del Garda, an Italian center of excellence for thyroid disease, published their experience on BTN Uncooled Microwave Ablation. A novel, dedicated procedure – the fluid-motion technique – was developed and implemented to obtain faster and potentially more effective ablations in all kinds of nodules, with a further confirmation of the results obtained at different European site.
US-Guided Percutaneous Microwave Ablation for Benign Thyroid Nodules by Dr. Leonor Fernandes et al.
On September 2024, Dr. Fernandes (Hospital Santa Maria, Lisbon) presented their initial experience on 48 patients, confirming that MWA of thyroid benign nodules is well tolerated, cost & risk effective vs. surgery and radioiodine therapy. Retreatment, if needed, can be done safely and effectively (5 patients were retreated within 12 months). To avoid regrowth, ablation of at least 70-80% of the nodule should be obtained.
Results Of Thyroid Nodule Ablation With Uncooled Microwave Systems, Facts And Truths by Prof. G. Yildirim et al
In April 2025 Dr. G. Yildirim updated her personal results with 3 years follow-up on 45 BTN patients. 5 pts undergone a second treatment at 6 month and N. 3 pts, at 12 months. In these patients the mean neutrophil-to-lymphocyte ratio (NLR) was higher (prognostic factor). Mean initial volume for pts requiring a second ablation was 46.45cc, vs. 19.51cc for patients undergoing a single-session procedure (p<0.01).
No major complications recorded.
17-18G MW antennas were utilized at 15W to reach 80-100C, obtaining cytotoxic effect, coagulative necrosis followed by phagocytosis. Inflammation response is key to necrotic tissue removal and prevention of regrowth.
Two-year clinical outcomes of microwave ablation for benign thyroid nodules: results from a multicenter study by Criscuoli, Alborino, Alberti, Casaril et Al. . European Journal of Endocrinology (Published on 6 Dec 2025).
This retrospective study included all consecutive patients treated at two thyroid centres of excellence from April 2021 to March 2024 with at least 12m of FU, representing the largest published European cohort of benign thyroid nodule patients treated with Uncooled MWA, using the “Fluid Motion” technique.
A total of 256 patients were treated with follow up (FU) of at least 12 months (baseline, 1m, 3m, 6m, 12m). Among these, a sub-group of N. 86 pts reached a final FU of 24m.
The results show that the maximum volume reduction was obtained already at 6 months, suggesting a superior performance compared to Radiofrequency Ablation which may take up to 12 month to achieve the best response in terms of VRR.
Reduction of symptoms and cosmetic improvements were observed at all FU. Data from the sub-group with 24m FU confirmed the whole cohort results.
Complications were rare (7%), mild to moderate and frequency was in line with previously published literature for RFA and MWA.
Large and very large nodules were successfully treated, regardless of the initial structure, indicating the potential effectiveness and safety of the Fluid Motion technique with uncooled MW for the majority of BTN.
Comparison of two ablation methods in benign thyroid nodules: Radiofrequency ablation and non-cooled microwave ablation, by Dr. Karacay et Al.
This retrospective study evaluates the effectiveness and complication rates of TATO non-cooled microwave ablation (MWA) system compared to radiofrequency ablation (RFA) system for treating benign thyroid nodules.
62 nodules (56 patients) were included.
At 3, 6, and 12 months, volume reduction was significantly greater in the TATO MWA group.
According to the authors the primary reason appears to be the reduced carbonization achieved through the use of lower power settings compared with RFA. The same principle, would explain why in previous studies, Cooled MWA systems did not perform better than RFA, given the use of higher power settings that can generate carbonization.
In addition, the lower power used with TATO MW system results in fewer microbubbles, thereby preserving the visibility of the ablated area.
Nodule composition significantly affects treatment success, with spongiform and semi-solid nodules responding better to ablation than purely solid nodules
More publications are in the making in Europe, that will be made available to the thyroid community soon.
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