Microwave surgery: Hepatectomy using a microwave tissue coagulator

Tabuse, Katsuyoshi; Katsumi, Masaharu; Kobayashi, Yasuhito; Noguchi, Hiroyuki; Egawa, Hiromu; Aoyama, Osamu; Kim, Hideo; Nagai, Yugo; Yamaue, Hiroki; Mori, Keiichiro; Azuma, Yoshinori; Tsuji, Takeshi

doi:10.1007/bf01656265

Cited by 172 publications

(87 citation statements)

References 8 publications

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“…and the amount of power delivered to tissues (50-150 W) with the lesion size. Eight time increments (2,4,6,8,10,12,16 and 20 min) and five power increments (50, 75, 100, 125 and 150 W) were used, constituting 40 time-power combinations, and for each combination trials were performed in triplicate, resulting in a total of 120 ablations. The results showed that both the applied power and the treatment duration correlated well with the coagulation diameters (short and long axis) in a sigmoid curve fashion.…”

Section: Ex Vivo Experimental Studiesmentioning

confidence: 99%

“…Initially developed in the early 1980s to achieve haemostasis along the plane of transection during hepatic resections (2), MW coagulation of tissue surfaces proved slower than electrocautery units and produced deeper areas of tissue necrosis. These two characteristics, while making MW unsuitable for operative haemostasis, are potentially useful in the ablation of liver tumours.…”

Section: Introductionmentioning

confidence: 99%

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Hepatic microwave ablation: a review of the histological changes following thermal damage

Gravante

Ong

Metcalfe

et al. 2008

Liver International

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Microwave (MW) ablation therapy is a local treatment by which tumours are destroyed by coagulation from the passage of MWs into cells. The aim of this review is to examine histological results obtained from preclinical and clinical studies. A literature search was undertaken for all studies focusing on MW therapy and in which lesions were excised for a complete histopathological examination after treatment. Two main zones were described after ablative therapy (central and transitional Microwave (MW) coagulation therapy is a form of local ablation where tumours are destroyed by thermal coagulation that develops from the passage of MWs into cells and the production of frictional movement between molecules (1). Initially developed in the early 1980s to achieve haemostasis along the plane of transection during hepatic resections (2), MW coagulation of tissue surfaces proved slower than electrocautery units and produced deeper areas of tissue necrosis. These two characteristics, while making MW unsuitable for operative haemostasis, are potentially useful in the ablation of liver tumours. Like radiofrequency (RF) ablation and laser-induced interstitial thermotherapy, MW is very versatile and can be performed percutaneously using ultrasound or computed tomography (CT) guidance, or at laparoscopy or laparotomy with intra-operative ultrasound guidance.The formation of the thermal lesion during the ablation process is a complex combination of MW energy absorption, heating conduction and possible tissue water evaporation, condensation and movement. In 2002, Izzo (3) suggested that the production of very small zones of coagulative necrosis by the intratumoral MW-emitting needle electrodes would require frequent repositioning at 5-10 mm intervals to create multiple overlapping zones of coagulative necrosis. He also suggested that MW should not be performed near major bile ducts and blood vessels because of the description of vascular and biliary complications in these locations. However, since the appearance of that review, numerous technical advances have been introduced in MW engineering and subsequently evaluated histologically in a number of preclinical and clinical studies.The aim of this review is to examine those studies and determine the factors that influence the production of an area of ablation and the evidence for its use under different circumstances. Materials and methodsA literature search was undertaken for all studies focusing on MW ablative therapy where lesions were excised for a complete histopathological examination after the treatment.Articles were selected from the MEDLINE, EMBASE and Cochrane Library databases, using the key words microwave, ablation or ablative therapy, liver, hepatic, in vivo, ex vivo, clinical, experimental. Only articles published in the English literature were used. We

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Section: Ex Vivo Experimental Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hepatic microwave ablation: a review of the histological changes following thermal damage

Gravante

Ong

Metcalfe

et al. 2008

Liver International

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“…MWA showed higher rates of complete ablation (75 %) with fewer sessions and a lower incidence of tumor recurrence (p = 0.02) with 13.7 months of survival. In summary, MWA showed better results in comparison to TACE alone even in large HCCs [6].…”

Section: Mwa Results In Hccmentioning

confidence: 83%

“…Microwave coagulation was developed in the early 1980s during hepatic resection in order to achieve hemostasis [6] and has substantially changed the field of thermal ablation in interventional oncology. Thus the term "microwave ablation" should replace the less succinct terms "percutaneous microwave coagulation therapy" and "microwave coagulation therapy" [4,7].…”

Section: Background and Definitionmentioning

confidence: 99%

Microwave Ablation (MWA): Basics, Technique and Results in Primary and Metastatic Liver Neoplasms – Review Article

Vogl

Nour-Eldin

Hammerstingl

et al. 2017

Fortschr Röntgenstr

140

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ZUSAMMENFASSUNGHintergrund Der lokoregionale interventionelle onkologische Behandlungsansatz ist eine anerkannte Behandlungsoption bei Lebermalignomen, insbesondere beim hepatozellulären Karzinom (HCC) und oligonodulären Lebermetastasen. Material und Methode ABSTR AC T PurposeThe locoregional interventional oncological treatment approach is an accepted modality for liver neoplasms, especially for hepatocellular carcinoma (HCC) and oligonodular liver metastases. Materials and MethodsThe main aim of ablation therapies like microwave ablation (MWA) is to eradicate all malignant cells in a minimally invasive technique under imaging guidance while preserving the healthy tissue with a sufficient safety margin (at least 5 mm) surrounding the ablated lesion.Results Ablation therapy can be performed via a percutaneous, laparoscopic or intraoperative approach under ultrasound, MRI or CT guidance for adequate localization and monitoring of the ablation process.Conclusion Ablation is the method of choice for oligonodular HCCs ≤ 3 cm. The technical success rate varies from 88 % to This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.98 % and progression-free survival (PFS) at 3 years from 27 % to 91.7 %. The same criteria apply to the therapy of liver metastases. Key Points▪ Careful selection of patients proves to be essential for optimum results of MWA ▪ Interventionists should be familiar with all aspects of complication and rapid assessment of imaging methods in order to evaluate induced damage by thermal ablation ▪ MWA seems to have some advantages over radiofrequency ablation, like shorter ablation time, less pain, less heat sink effect; however, scientific proof is needed

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“…Several studies have suggested the use of radiofrequency (RF) or microwave ablation in conjunction with hepatic resection [8][9][10][11] . In this technique, a plane of tissue is coagulated by sequential applications of microwave or radiofrequency energy, using conventional ablation electrodes.…”

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confidence: 99%

An electrode array that minimizes blood loss for radiofrequency-assisted hepatic resection

Schutt

O’Rourke

Will

et al. 2008

Medical Engineering & Physics

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Hepatic resection is currently the standard treatment for liver cancer. During hepatic resection part of the liver containing the tumor is surgically removed. This type of surgery is accompanied by high blood loss of ~0.6 -1.35 L. Blood loss is associated with increased complication rates, prolonged hospital stay, and reduced patient survival, especially when transfusion is required. Other researchers have suggested using radiofrequency (RF) or microwave ablation to coagulate a tissue slice before resection to reduce blood loss, but conventional devices typically take several hours. We developed a device consisting of a linear array of blade-shaped, 1cm wide radiofrequency (RF) electrodes 1.5 cm apart. Bipolar RF power is applied between pairs of adjacent electrodes, leading to high tissue temperatures between the electrodes that promote coagulation of large vessels (>mm) in the resection plane. Rapid switching of applied power between pairs of adjacent electrodes allows simultaneous heating and coagulation of the entire resection plane within 3 -6 min. In 7 in-vivo trials in a porcine model, resection along a plane pre-coagulated with the device resulted in little (<20 mL) to no blood loss, while coagulating all vessels (up to 4.5 mm diameter in this study). Average treatment time (from placement of the device to transection) was 6.8 ± 0.5 min when 4 electrodes were used, and 11.3 ± 1.2 min when 5-7 electrodes were used. This device may reduce blood-loss related morbidity during resection and reduce treatment time by coagulating all vessels in the resection plane.

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Microwave surgery: Hepatectomy using a microwave tissue coagulator

Cited by 172 publications

References 8 publications

Hepatic microwave ablation: a review of the histological changes following thermal damage

Hepatic microwave ablation: a review of the histological changes following thermal damage

Microwave Ablation (MWA): Basics, Technique and Results in Primary and Metastatic Liver Neoplasms – Review Article

An electrode array that minimizes blood loss for radiofrequency-assisted hepatic resection

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