Laparoscopic Microwave Ablation: Which Technologies Improve the Results

Abstract

Liver resection is the best treatment for hepatocellular carcinoma (HCC) when resectable. Unfortunately, many patients with HCC cannot undergo liver resection. Percutaneous thermoablation represents a valid alternative for inoperable neoplasms and for small HCCs, but it is not always possible to accomplish it. In cases where the percutaneous approach is not feasible (not a visible lesion or in hazardous locations), laparoscopic thermoablation may be indicated. HCC diagnosis is commonly obtained from imaging modalities, such as CT and MRI, However, the interpretation of radiological images, which have a two-dimensional appearance, during the surgical procedure and in particular during laparoscopy, can be very difficult in many cases for the surgeon who has to treat the tumor in a three-dimensional environment. In recent years, more technologies have helped surgeons to improve the results after ablative treatments. The three-dimensional reconstruction of the radiological images has allowed the surgeon to assess the exact position of the tumor both before the surgery (virtual reality) and during the surgery with immersive techniques (augmented reality). Furthermore, indocyanine green (ICG) fluorescence imaging seems to be a valid tool to enhance the precision of laparoscopic thermoablation. Finally, the association with laparoscopic ultrasound with contrast media could improve the localization and characteristics of tumor lesions. This article describes the use of hepatic three-dimensional modeling, ICG fluorescence imaging and laparoscopic ultrasound examination, convenient for improving the preoperative surgical preparation for personalized laparoscopic approach.

Integrating Navigation-Assisted Ablation in the Locoregional Treatment of Hepatocellular Carcinoma

“…2 The development and implementation of locoregional therapies, including ablative technologies (eg, radiofrequency ablation [RFA] and microwave ablation [MWA]), offers a definitive treatment modality for early-stage, smaller tumors. [3][4][5] Ablative therapies have evolved over the last 2 decades, showing promise as a robust alternative to surgical resection in select patients. 6,7 Randomized clinical trials report similar outcomes between surgical resection and RFA, with RFA treatment being less invasive and resulting in shorter hospital stays.…”

“…The development and implementation of locoregional therapies, including ablative technologies (eg, radiofrequency ablation [RFA] and microwave ablation [MWA]), offers a definitive treatment modality for early-stage, smaller tumors . Ablative therapies have evolved over the last 2 decades, showing promise as a robust alternative to surgical resection in select patients .…”

Enhancing Patient Outcomes through Microwave Ablation in Hepatic Malignant Tumors: Insights on Recurrence Factors

“…Unlike surgery or radiation therapy, which can be invasive and carry signi cant side effects, MWA uses microwave energy for targeted tumor cell elimination. This approach not only achieves effective local ablation but also reduces the side effects often seen with conventional treatments [9,10,11,12]. MWA's minimally invasive nature and its ability to preserve healthy liver tissue make it particularly advantageous for patients who might not be suitable for more aggressive treatments.…”

“…Hence, the Child-Pugh classi cation has emerged as a crucial framework for guiding treatment strategies in patients with malignant liver tumors. While there has been a gradual increase in research on percutaneous microwave ablation for malignant liver tumors in recent years, the majority of studies have been limited in scale and struggle to offer robust guidance for clinical practice [9,10,11]. Furthermore, the current research ndings remain inconclusive regarding the in uencing factors of microwave ablation therapy, such as Child-Pugh classi cation, lesion size, and the number of lesions.…”

What Is the Role of Minimally Invasive Liver Surgery in Treating Patients with Hepatocellular Carcinoma on Cirrhosis?

“…In fact, minimally invasive liver surgery (MILS), such as laparoscopic and robotic techniques as well as image-guided ablation therapies, have emerged and established themselves as effective alternatives to traditional open surgery for patients with HCC [ 5 , 6 ]. As for other cancers, minimally invasive surgery has brought relevant advantages regarding early postoperative outcomes [ 7 , 8 ].…”