Microwave coagulation therapy (MCT) for liver tumors had initially developed in Japan and now is spreading worldwide. Microwave thermosphere ablation is a new concept using cooling antenna to create a larger spherical necrotic area. Recently, the indications of MCT is spreading from hepatocellular carcinoma to liver metastases. MCT is recommended only for patients with unresectable colorectal liver metastases (CRLM); ≤ 3cm and ≤ 3 nodules in combination with systemic chemotherapy. MCT has some benefits compared with radiofrequency ablation: 1) Shorter ablation time; 2) Lower local recurrence rate; 3) better disease-free and overall survival; 4) Complete necrosis even for the tumor adjacent to the large vessels; and 5) Similar complication rates. In summary, MCT is evolving as one of the promising local treatments for liver metastases; however, a randomized control trial is required to create solid evidences.
Microwave and radiofrequency ablation are very effective local treatment for patients with liver metastasis. In the worldwide, it has been widely used alone or in combination with other treatments such as hepatectomy and chemotherapy for patients with various conditions. However, there is no evidence of ablation therapy for patient with liver metastasis. This time, we researched the current status and usefulness of local ablation therapy for metastatic liver cancer from the past literature, and discuss future issues.
A 74-year-old woman visited our hospital for consultation for a liver mass that was found during treatment at another hospital for alcoholic hepatitis and cirrhosis. Two subtypes of hepatocellular carcinomas (HCCs) were found: S2 and S4 HCCs that were 13 and 10 mm in size, respectively. A radiofrequency ablation was performed for the S4 HCC. Furthermore, the S2 HCC was treated via a laparoscopic partial liver resection. The range of the tumor was confirmed by ultrasonography, a site 10 mm from the tumor was used as the planned dissection line, and ablation was performed at an interval of 1 cm with 55 W for 30 seconds using Microtase. The liver was dissected and a partial hepatic resection was performed for the S2 HCC. The patient was discharged on postoperative day six without any obvious postoperative complications. After 14 months, the postoperative course has been uneventful with no recurrence noted. The use of Microtase in a patient who underwent laparoscopic liver resection suggests that it may be sufficient to control hemorrhages in cases of liver cirrhosis such as in the present case.
Microwave endometrial ablation at a frequency of 2.45 GHz is effective for the treatment of hypermenorrhea: A clinical investigation at our hospital Objective: The goal of the study was to investigate microwave endometrial ablation (MEA) at a frequency of 2.45 GHz as a low-invasive alternative to hysterectomy for the treatment of hypermenorrhea.Subjects and Methods: The subjects were 57 patients treated with MEA between January 2016 and December 2018 in our department.Hypermenorrhea, menstrual pain, and satisfaction with treatment were evaluated using visual analog scales (VAS) 6 months post-treatment.Hb levels before and after MEA were also investigated.Results: VAS scores for hypermenorrhea and menstrual pain significantly improved from 10 before treatment to 1.2±1.3 and 1.6±2.0,respectively, after treatment (p<0.001).Hb significantly increased from 8.8±2.2 to 13.2±1.3g/dlfrom before to after MEA (p<0.001).Strong satisfaction with MEA was indicated by a VAS score of 9.5±0.7.Conclusion: MEA may be useful for the treatment of hypermenorrhea as an alternative to hysterectomy.
We investigated outcomes of menorrhagic patients observed more than 6months treated with microwave endometrial ablation (MEA), because the longterm outcomes of this modality are still unknown.
Background : Radio-frequency ablation (RFA) is a less invasive treatment than hepatic resection for patients with a damaged liver. The aim of the current study was to clarify prognostic factors for patients with hepatocellular carcinoma (HCC) who underwent RFA on a recurrent lesion in the liver after curative hepatectomy.
Aim: There is no definite view on initial treatment selection for hepatocellular carcinoma (HCC) less than 3 cm. In our institute, treatment results of local ablation therapy and clinicopathological examination of small HCC, “Less than 3 cm in diameter with simple nodule type or small nodular with indistinct margin in gloss type” was established as the therapeutic indication criteria of percutaneous radiofrequency ablation therapy (RFA). We have introduced it as a part of treatment strategy. This time, we compare the treatment results of RFA and hepatectomy after that and examined whether the therapeutic indication criteria of RFA in our institute was reasonable or not.
Background : We evaluated the surgical outcomes of non-ischemic, non-renorrhaphy Laparoscopic partial nephrectomy (LPN) using a microwave tissue coagulator (MTC) for small renal tumors.
Lung cancer is the leading cause of cancer-related deaths worldwide. Surgical resection is the standard treatment for primary lung cancer. However, the critical morbidity after surgical resection, especially in patients with octogenarian, chronic obstructive pulmonary disease, or pulmonary fibrosis, is problematic. In chest surgery, minimal invasiveness, especially video-assisted thoracic surgery and a less radical resection is an important topic. Perioperative respiratory rehabilitation is useful for preventing postoperative complications. We discuss about recent topics of treatment in patients with lung cancer.
An increase in tissue temperature or impedance (IMP) has each been used as endpoints for an ablation with monopolar radiofrequency induced thermotherapy (RFITT) system. In contrast, endpoint for an ablation using bipolar RFITT system is given by the total delivered energy that is determined depending on the types and number of applied needles (applicators). However, treatment endpoint defined by the delivered energy alone is associated with an increased risk for insufficient ablation. This experimental study verified optimal endpoint for bipolar ablation using ex-vivo porcine liver. We found that actual power output (“Power Effect” (PE)) and IMP were electrotechnically essential as indices for sufficient coagulation. In all experiments, sufficient coagulation was obtained when the procedure was finished after PE was below 5W and IMP between each electrode become higher than that of baseline. Using this endpoints, sufficient coagulation was achieved even when applicators were inserted with distance of 50 mm, which was longer than the recommended distance by dosimetry table. In addition, with applicators distance of 13 mm or less, shorter ablation time and smaller delivered energy than their recommended values were available to obtain sufficient coagulation.
We have performed laparoscopic hepatectomy (LH) to treat HCC in patients with cirrhosis. In patients with hepatic cirrhosis, the perioperative blood control in cirrhotic patients is more important procedure than that in normal liver patients. Since we initiated LH, the use of pre-coagulation technique with microwave obtained satisfactory hemostasis during liver parenchymal transection. We retrospectively investigated 35 HCC patients with cirrhosis who had performed laparoscopic partial hepatectomy using pre-coagulation. Pre-coagulation technique with laparoscopic coagulation shears was able to performed LH in all cases without Pringle maneuver. Intraoperative blood loss averaged 206.8±234.0 cc. The study group had one case of grade II prolonged fever, two cases of grade II ascites, and one case of grade IIIa biliary fistula. The postoperative length of stay averaged 10.8±5.2 days. Although the development of the energy devices and Pringle maneuver have decreased the use of pre-coagulation technique especially in normal liver, pre-coagulation technique is one of useful options in laparoscopic partial hepatectomy for HCC patients with cirrhosis.
We incidentally experienced a case of leiomyoma with latent endometrial carcinoma treated with microwave endometrial ablation (MEA) to control massive menorrhagia by leiomyoma. In the endometrial curettage sample which was obtained during MEA treatment, well differentiated endometrial carcinoma with minimum myometrium invasion was found. The total hysterectomy with both adnexetomy was performed 40 days after MEA. The detail histological examination of excised uterus, both tubes and ovaries had no remaining endometrial carcinoma tissues except for presumable degenerated carcinoma cells within 4 mm depth in myometrium. This report indicates some early case of endometrial carcinoma could be treated with MEA.
【Objectives】The aim of the study is to evaluate the safety and effectiveness of microwave endometrial ablation (MEA) in women with nodular adenomyosis for office-based gynecology. 【Methods】Twelve outpatients (average age:46.5) who hoped to avoid hysterectomy underwent MEA with transcervical microwave adenomyolysis (TCMAM) for the treatment of menorrhagia due to nodular adenomyosis whose maximum diameter was 53.4±11.3mm. 【Results】The mean operation time was 20.1±4.9 min. The blood loss during a monthly menstrual period decreased to 1.4 (0~5) on VAS score (score before operation =10). The VAS score of dysmenorrhea decreased to 1.1 (0~4) . The average VAS score regarding feelings of satisfaction for MEA was 9.7(full score =10). 【Conclusion】MEA with TCMAM is feasible for treatment of both menorrhagia and dysmenorrhea due to nodular adenomyosis in office day surgical procedure.
The precision of treatment and the diagnosis hepatocellular carcinoma improves by the progress of the supersonic wave model. Using this model which can display echography to the same screen in real time as reference such as CT or MRI. Because there was an opportunity to do RFA (radiofrequency ablation) for us using Smart Fusion carried in Toshiba APLIO500, we report it.
In a laparoscopic hepatectomy, it is important to control bleeding from liver parenchyma. Microwave pre-coagulation is an effective technique to achieve good hemostasis during hepatic resection. On the other hand, there is a suspicious risk of causing bile leakage and bile duct strangulation due to the biliary damage after microwave coagulation. We report a case of hepatic biloma after laparoscopic partial hepatic resection for hepatocellular carcinoma using microwave pre-coagulation.
Sorafenib has been established as a standard therapy to prolong survival in patients with advanced hepatocellular carcinoma patients when locoregional therapy is not indicated; however the benefit of hepatic arterial infusion chemotherapy (HAIC) as an alternative option remains controversial. Although further research to optimize the use of HAIC and sorafenib is ongoing, we present an overview of the factors influencing the management of long-term survival following sorafenib or HAIC treatment.
An estimated 6 million women in Japan suffer from excessive menstruation and the treatment of this disorder has been undergoing dramatic changes recently. In April 2012, microwave endometrial ablation (MEA) was approved for insurance coverage as a K863-3: a hysteroscopic endometrial ablation (17810 points). Since the introduction of MEA to Shimane University Hospital in August 2007, we have performed the procedure in 96 patients with excessive menstruation. Authors evaluate and report its safety, its effcacy, and its complication.
Of the 1635 patients with hepatocellular carcinoma receiving initial treatment at our hospital, 297 received local ablation therapy and 592 underwent hepatectomy. The prognosis and background factors of these patients were compared in this study. No significant difference was noted in the cumulative survival rate between the local ablation therapy and hepatectomy groups. However, with regard to background factors, the local ablation therapy group had significantly poorer hepatic functional reserve, smaller tumor size, and a lower proportion of patients with progressive stage disease. Accordingly, further investigation was conducted in a similar manner to correct for these differences in background factors. We limited the target hepatocellular carcinoma patients to those with liver damage grade A and a single tumor of ≤2 cm. Although no difference was found in the cumulative survival rate between the local ablation therapy and hepatectomy groups, the cumulative non-recurrence survival rate was significantly more favorable in the latter. However, serum albumin levels were significantly lower and tumor size was smaller in patients who received local ablation therapy than in those who underwent hepatectomy, despite the inclusion of only those patients who met the aforementioned conditions of liver damage grade and tumor size. Similarly, the results of specific local ablation therapies, including percutaneous ethanol injection therapy, percutaneous microwave coagulation therapy, and percutaneous radiofrequency ablation, were compared with those of hepatectomy in patients with liver damage grade A and a single tumor of ≤2 cm in size. However, the results indicated no difference in the cumulative survival rate. In conclusion, the cumulative survival rate did not differ between patients who received local ablation therapy and those who underwent hepatectomy, even on limiting the subjects to patients with liver damage grade A and a single tumor of ≤2 cm.
Purpose: CT volumetrics are used to investigate energy applied to volume of ablated liver parenchyma in patients who underwent single antenna, single application (SA-SA) microwave ablation (MWA). Methods: Retrospective review was performed of all patients undergoing hepatic MWA. Two groups were identified: patients with hepatocellular carcinoma and cirrhosis and those with other malignancies without cirrhosis. Ablation volumes were calculated using open source imaging software. Results: 192 patients underwent 338 different tumor ablations. 16 patients with 23 lesions were included. Linear and non-linear regression models were calculated. Evaluation of the cirrhotic group with non-linear logarithmic regression yielded the best fit model of volume achieved to energy applied (MSE 145, R2=0.78). No predictive model was calculated in non-cirrhotics(MSE 615, R2=0.02). Conclusions: Volume ablated to energy applied ratio in cirrhotics yielded a strongly correlated predictive model; nocorrelation was found in non-cirrhotics.
The aim of the study is to evaluate the safety and effectiveness of microwave endometrial ablation (MEA) in women with submucous myomas for office-based gynecology. Thirty outpatients (average age : 44.6 years) who hoped to avoid hysterectomy received MEA for treatment of menorrhagia due to submucous myomas. The patients were divided into two groups according to the maximal myoma size. Group A (21 cases) in which node is less than 3 centimeters treated by MEA. Group B (9 cases) in which node is over 3 centimeters was treated by MEA with transcervical microwave myolysis (TCMM). The mean operation time were in Group A; 17.7 and in Group B; 18.5 min. The blood loss during a monthly menstrual period decreased in Group A; seventeen (80.9%) and Group B; eight (88.8%) patients to less than 20%, Group A; three (14.2%) and Group B; one (11.1%) patient to less than 50%. Menorrhagia remained in Group A; one (4.7%) and in Group B; no patient after treatment. Three patients (14.2%) of Group A and one (11.1%) of Group B had mild endometritis within a month after treatment. The average VAS score regarding feelings of satisfaction for MEA were 8.8 (Group A) and 9.2 (Group B)(full score=10). MEA with TCMM is feasible for treatment of menorrhagia due to submucous myomas in various size and it may be useful for a office day surgical procedure that is minimally invasive for who hoped to avoid hysterectomy.
