The urinary bladders of dogs were irradiated experimentally with microwaves in order to examine thermal distribution and histological changes after microwave irradiation. A clinicopathological evaluation was also performed using bladder cancer specimens treated by microwave coagulation therapy. The present study indicates that microwave coagulation therapy is a safe and useful procedure for the local control of muscle-infiltrating bladder cancer for the following reasons: 1) Perforation of the bladder wall is not required to conduct this therapy. 2) The thermal effects of microwaves that spread through the profound portion of the muscle layer of the bladder result in sufficient necrosis. Degeneration with pyknosis of nuclei was observed in the peripheral region. Three months after microwave coagulation, granulation formed; 6 months after microwave coagulation, the coagulated region became scarred.
In our clinic, since 1985 transurethral microwave regional coagulation therapy (MRC) has been performed for patients with urinary bladder cancer as a bladder preserving procedure. The survival rate and the prognostic significance of clinical and pathological variables were investigated in 29 patients who had undergone MRC to invasive urinary bladder cancer (T2, T3NOMO). The prognosis of the patients resulted in the survival rate of 68%(G1, G2: 80%, G3: 51%) after 5 years. Six patients died of cancer. Five of these patients had G3 cancer. The death rate of patients with G3 cancer was significantly higher than those with G1 and G2 cancers. With MRC the preservation rate of the urinary bladder was 79%(23/29). In conclusion, these results indicate that we might be able to treat the invasive urinary bladder cancer without total cystectomy, applyting MRC to that of G1 and G2.
The report of colonofiberscopic therapy using a microwave coagulator is relatively rare. Recently, we epxperienced colonofiberscopic microwave coagulation therapy for a polypectomy, hemostasis and tumor reduction. We could perform this therapy in 12 cases using by endoscopic microwave probe, ball type and rod type. The complication of this therapy was free. It is presumed that this procedure is useful and recommendable for colonofiberscopic treatment.
In order to obtain more large coagulation area by percutaneous microwave tissue coagulation in liver, the combination method of microwave tissue coagulation (MTC) and radiofrequency hyperthermia (RFH) was examined experimentally. The THERMOTORON-RF8 (Yamamoto-vinita Ltd.) was used as the RFH system in this study. Alternative irradiation between MTC (70 watt) abd RFH (peak: 900 watt) every 30 seconds was performed as the combination method (MTC-RFH). As the control experiments, every 30 seconds intermittent irradiation of the MTC or RFH was performed, respectively. The phantom study in agar revealed that (1) the temperature near the needle-electrode of the MTC was expressly raised by RFH in spite of the absence of microwave irradiation, and that (2) at the point of 25mm distance from the needle-electrode of the MTC the most rise in temperature was obtained by MTC-RFH. In the experiment on liver tissue under anesthetized pig (body weight 20kg), (3) the bullet shaped coagulation area which the diameter was about 30 mm width was found in the MTC-RFH, while the teardrop shaped coagulation area was found in the MTC.(4) It was found the skin where the needle-electrode of the MTC penetrated it was burned maybe due to heat in the needle-electrode induced by RFH. Accordingly the combination of MTC and the RFH can enlarge the tissue coagulation area, but the problem to control heating around the needle-electrode of the MTC induced by RFH is remained.
Three cases of locally advanced breast cancer, witch could not be performed enbloc surgical resection, were treated with microwave tissue coagulator. The first case was 50 year-old male with lung and multiple bone metastasis. The second case was 60 year-old female with lung metastasis and the third case was 72year-old female with lung and bone metastasis. Microwave antenas were inserted into the tumor tissue on the border line between the tumor and surrounding normal tissue (interstitial therapy). Microwave coagulation was performed step by step continuously. Then, inner part of tumor tissue was cut off apart from normal tissue on the line of microwave coagulation. A small outer part of coagulated or non-coagulated tumor tissue was remained as the result of this procedure. For the first case, microwave coagulation was done again to the remaining tumor and myocutaneous flap using M. latissimus dorsi was transplanted on the part of the skin defect. The patient died after 11 months from the first treatment. No local recerrence was recognized and quality of life could be kept good until his death.The second case died 13 days after the treatment because of deteriolation of pleuritis carcinomatosa. For the third case, microwave coagulation was done twice as the first 2 cases. The patient died 23 months after this procedure. Skin defect healed almost completely and no local recurrence was recognized. Also, each case was received CAF therapy. From the experiences of these three cases, interstitial therapy with microwave tissue coagulator could be thought available to control local tumor growth for unresectable breast cancer.
The superior coagulation capacity of the application of microwave energy in tissue has been established in hepatectomy and endoscopic therapy. We report the application of microwave energy in a case of massive rectal bleeding. Fifty-six year-old man was admitted in our hospital with complaint of massive rectal bleeding from the recurrence of rectal cancer on February 3 1992 who received low anterior resection 2 years ago. Anemia and poor nutrition were seen. We performed microwave coagulation therapy through anal approach under spinal anesthesia and endoscopically. Afther coagulation therapy, rectal bleeding has redused extremely and general condition recovered. The patient discharged on July 7. Merits of postotreated course is pointed following two (1) recovered anemia and malnutorition, (2) able to have high QOF.
The case is 81 years old female whose chief complaint was dysphasia since December 1991. Upper gastrointestinal examination revealed about 6cm malignant stenosis in the middle esophagus. To maintain oral food intake, in July 1992, the lesion was coagulated and reduced by 3 times endoscopic microwave coagulation therapy (EMCT) through the Witzel's type gastrostomy which had been made under local anesthesia in February 1992. The endoscopic treatment through the gastrostomy freed patient from the pharyngeal discomfort. Continuous suction of the air through the gastrostomy freed the patient from abdominal fullness. Slight head-up position during the treatment kept the endoscopic view fine because the bloody mucus sprung from coagulating tissue were drained to the stomach without stagnation. Endoscopic therapy though the gastrostomy is worth trying. This route enabled us more than one hour treatment of the EMCT.
We reported a case to perform simultaneous laparoscopic cholecystectomy and fenestration of a liver cyst using a newly deviced microwave scalpel (blade type electrode). A 40-year-old female was admitted our hospital with a chief complaint of upper abdominal discomfort. Abdominal US and CTscan revealed the liver cyst in the left lateral segment of the liver. The cyst was monolocular, 6.1×5.3cm in size, and protruded from liver surface to lateral aspect. At the same time a gall stone was recognized. No communication was detected between the intrahepatic bile duct and the liver cyst by (ERC). On February 18th, 1992, laparoscopic cholecystectomy and fenestration of the liver cyst were performed simultaneously. Using the microwave scalpel, any bleeding was observed during the course of the operation. Laparoscopic fenestration of the liver cyst was a technically easy and useful surgical procedure. The dissection (procedure) was possible with adequate hemostasis using the newly deviced microwave scalpel, and it was possible to perform the operation safely.
For the purpose of testing the possibility of its effecive use in the decerebration of intracranial tumors, the Japanese-made HS-15 2450MHz microwave operative intrument was first tried on egg white and rabbit brains. The data so obtained were successfully applied clinically to the decerebration of 34 cases of large-sized intracranial tumors with rich blood kinesis, of which 18 were cases of meningiomas, 11 were cases of gliomas, 3 were cases of intracranial metastatic tumors. one was a case of angioreticuloma of cerebellum and one was a case of acoustic neurinoma. The tumors measured 6.1×5.0×3.8cm on the average and the amount of blood transfused averaged 650ml. All 34 patients were cured and discharged. Discussions were held as to the adjustment of power output and timing according to the size and location of the tumor, and the appropriate length of the microwave antenna. The instrument has been found to possess a number of outstanding features: effective hemostesis, neat and tidy field of operation, simple handing and easy mastery; and when combined with the CUSA, the instrument considerably reduces the operative technique. The HS-15 2450 microwave operative instrument has been found to be a safe and reliably surgical tool.
Fragestellung: Mit Hilfe eines neuen Gerëtes ist es möglich, eine Gewebekoagulstion parenchymatöser Organe durch Applikation von Mikrowellen zu arreichen. An der Leber ist des Gerat sowohl Resektion als auch zur Destruktion irresektabler Metastasen einsetzbar, Far beide Indikationsbereiche solltener Erfahrungen gewonnen werden. Methopik: In dem verwendeten Gerät werden Mikrowellen mit einer Frequenz von 2, 450±50MHz erzeugt, die meximale Leistung betrëgt 150W. Die Ubertragung der Mikrowellenanergie erfolgt mit Nadelelektroden, die in das Gewebe eingestochen werden. Ercebnisse: Des Gerät wurde bislang 7mal zur Leberresoktion und 5mal zur Matastasendestruktion aingesetzt, Bei den Resoktionen war eine sehr gute Hämoatase erraichbar, bei exakter Einhaltung der zuvor durch Mikrowellen verkechten Ebene lieB sich fast vollständig ohne Blutverlust arbeiten, Nachteilig war ein deutlich höherer Zeitaufwand als bei konventioneller Tachnik, Metastasendestruktionen waren bei oberflëchennahen Tumoren mit einem Durchmesser bis zu 2cm völlig unproblametisch; bei groBeren und tiefar gelegenen Tumoren wirkte sich storend aus, daB o'is erreichte Nekrosezone makroskopisch nur schwer abschatzbar war und daB such das Uber dem Tumor liegende gesunde Gewebe verkocht wurde. Abgesehen von ainem Gallelack nach Mikrowellen-unterstützter Resektion, wurden keine Komplikationen baobachtet. Schlussfolgerungen: Das Mikrowellenkoagulationsgerät het sich in der erstan Erprobung ais goeignetes Hilfsmittel zur Leberresaktion erwissen, Resektionen sind zwar zeitaufwendig, können aber dank der guten Hämostase ohne Hilusokklusion durchgeführt werden. Insbesondere für Zirrhosepatienten ist dies ein Vortell, Daruberhinaus 1st mit dem Apparat auch die Destruktion kleiner, oberflächanneher Metastasen möglich, Durch z, Zt. in der Entwicklung befindliche Varbesserungen (z. B. laparoskopische Applikation; Mikrowellenskalpell) konnten dis Anwendungsmoglichkaiten noch ausgedehnt werden.