Radiotherapy is not first-line therapy for hepatocellular carcinoma. The indication is the difficult cases to do interventional radiology, microwave surgery and operation, especially huge tumors and tumor thrombus. Radiotherapy is effective for local control in dose dependency. The radiation dose escalation may improve treatment results, but complications may also be increased. Three dimensional conformal radiotherapy should be applied to escalate the radiation dose and to protect the remaining liver and adjacent organs in local radiotherapy for hepatocellular carcinoma. The bone metastases from hepatocellular carcinoma are increasing and good indication for radiotherapy. The purpose of the radiotherapy is decreased the feeling of pain and the tumor reduction.

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The second generation microbubble agent of ultrasound is introduced clinically in this country, and it was reported that many hospitals used it at the time of diagnosis for the liver tumor.
This time, we performed a three-dimensional and four-dimensional ultrasonography without using 2D mode as usual.
Also, we report it at the same time because we use RealTime 4D Biopsy mode put on this model in 4 case nodes. This time and performed RFA and revealed the improvement of the puncture attachment at this time.

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Objective: We evaluate the usefulness of Sonazoid^®-enhanced ultrasonography for nonsurgical local treatment for hepatocellular carcinoma (HCC).
Materials and Methods: We have performed Sonazoid^®-enhanced ultrasonography for liver tumors since May 2007. We treated 82 HCC nodules from January 2006 to April 2007 without Sonazoid^®-utilization and 97 HCC nodules from May 2007 to April 2009 with Sonazoid^®-utilization. We examined the detectability of HCC and efficacy of treatment in each period.
Results: Eleven nodules (13.2%) and 3 nodules (3.1%) were undetectable by ultrasonography before and after Sonazoid^®-utilization, respectively (p = 0.012). Residual tumor after local treatment existed in 7 of 71 nodules (9.9%) and 6 of 90 nodules (6.6%) before and after Sonazoid^®-utilization, respectively (p = 0.112).
Conclusion: Sonazoid^®-enhanced ultrasonography is a useful technique in treatment of HCC.

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Background: During radiofrequency ablation (RFA) and percutaneous ethanol injection (PEI), high echoic areas can be observed by ultrasound. No studies have definitively identified them. Therefore, we used an angioscope to observe the high echoic areas.
Subjects and Methods: Laparotomy was performed on 7 pigs. A 16-Fr sheath was inserted into the jugular vein. After inserting a 3.8-mm angioscope into the sheath, a guidewire was used to guide the angioscope to the hepatic vein, and RFA and PEI was performed.
Results: The outflow of bubbles was observed by angioscope in RFA. On the other hand bubbles were not observed in PEI.
Conclusions: High echoic areas in RFA are thought to represent steam generated by rapidly heated tissue. On the other hand, the mechanism of high echoic areas in PEI is due to the echo contrast between blood and ethanol.

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Differences of effect between microwave coagulation and radiofrequency ablation for patients with hepatocellular carcinoma who received laparoscopic thermal ablation therapies, have not been found in the previous report. In our institution, we select MCT or RFA in accordance with location of HCC. Usually, we select RFA when HCC are located at head side of liver and select MCT when HCC are located at caudal side (near organs) of liver. Thus, we investigate the differences between patients who were treated by MCT and RFA. As results, the longest diameter of HCC was larger in RFA patients than in MCT patients. And, the number of patients who had HCC at S3 was larger in RFA group than in MCT group. The efficacy was not different between MCT and RFA.

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Background: The control of bleeding from the liver parenchyma in laparoscopic hepatectomy is one of the important issues. In our department, the pre-coagulation method that the preceding coagulation of the resection line was done for the purpose of control of bleeding in parenchymal resection. MCT and RFA have been used for pre-coagulation. Recently, precoagulation by the soft coagulation that provides low voltage congelation under the control of impedance was introduced. In this study, we examined the utility of the different type of pre-coagulation in the laparoscopic hepatic resection.
Methods: The operative outcomes were compared with 55 patients who underwent laparoscopic partial hepatectomy for HCC with pre-coagulation method. The patients were divided into 3 groups depending on pre-coagulation device type, by MCT(M-EH), by RFA(R-EH), and by soft coagulation(S-EH).
Results: The background of patients in each device was not significantly different. The ratio of laparoscopic assisted operation in S-EH coagulation group is higher than the other devices. The intraoperative blood loss and operating time was not significantly different, but percent requiring blood product in M-EH group is higher than R-EH and S-EH coagulation group. Also the complication rate in M-EH group is higher than R-EH and S-EH coagulation group.
Conclusion: Pre-coagulation method by soft coagulation for laparoscopic hepatectomy represents a feasible technique with good control of bleeding. The pre-coagulation by S-EH is one of the choice which can be recommended.

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Objective: To analyze efficacy of microwave endometrial ablation (MEA) using a new curved applicator for treatment of menorrhagia.
Study Design: Ten patients received MEA for treatment of menorrhagia. Using a visual analog scale (VAS), MEA patients rated their menorrhagia, dysmenorrhea, and feelings of satisfaction from the procedure. The patients' intraoperative blood loss, operating time, and length of hospital stay were summarized. Mean blood loss, operating time, and mean length of hospital stay were also assessed.
Results: Following MEA, the VAS scores were significantly decreased in the MEA patients for menorrhagia (P<0.0001) and dysmenorrhea (P = 0.0002). The average VAS score regarding feelings of satisfaction for MEA was 8.9 (full score = 10).
Conclusion: MEA successfully controlled menorrhagia and achieved a high rate of satisfaction among patients.

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Purpose: To evaluate the hysterectomy rate after microwave endometrial ablation (MEA) using a curved microwave applicator in patients with a submucous myoma.
Materials and methods: Clinical records of 70 patients of menorrhagia who underwent MEA using a curved microwave applicator at Osaka City University Hospital between January 2001 and June 2008 were analyzed.
Results: 27 patients had been suffering from severe menorrhagia caused by a submucous myoma. Average age of the patients was 46.1±11.3 (Mean±SD) years and average cavity length was 10.9±3.7 (Mean±SD) cm at treatment. After the operation, 2 patients underwent hysterectomy due to recurrent menorrhagia and growing myomas; one with a uterine cavity 17.6cm at MEA was performed hysterectomy at 42 months, the other with a uterine cavity 14cm at MEA at 25 months. Hysterectomy rate was 7.4%.
Conclusion: MEA using a curved applicator treats successfully menorrhagia caused by a submucous myoma.

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We have performed transurethral microwave tissue coagulation (MTC) for urinary bladder cancer, and especially applied MTC to small recurrent tumors without anesthesia. We report 2 patients who underwent MTC for urinary bladder cancer as a primary therapy without anesthesia. Both cases were old age with some complications. One was 92-year-old man who had been performed pancreatoduodenectomy and colectomy, and medicated for diabetes and angina pectoris. Papillary tumor of posterior wall (3mm in diameter, UC, G2) was treated. After 11 months, MTC was performed for recurrent tumor which was 3mm in diameter. Another case was 90-year-old man with dementia. Papillary 10mm tumor was able to treat by MTC alone without anesthesia. It is supposed that MTC without anesthesia could be applied to small bladder cancer as a primary therapy.

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We evaluated the perioperative complications and preliminary oncological outcomes in patients with T1a renal cell carcinoma (RCC) who underwent non-ischemic retroperitoneoscopic partial nephrectomy by using a microwave tissue coagulator (MTC). Seventeen patients (11 men and 6 women) with T1a RCC underwent this procedure at our institute. The mean age and tumor size were 59 years (range: 33-80) and 26 mm (range: 15-40), respectively. The mean operation time and estimated blood loss were 212 min (range: 120-266) and 128 mL (range: 5-570), respectively. No patient received transfusion. No patient showed intra-operative and post-operative urine leakage, bleeding, ileus, wound infection or renal insufficiency. The mean follow-up period was 42 months (range: 1-90). During the follow-up period, no patient showed any local recurrence or distant metastasis, and all patients are alive without cancer now. Non-ischemic retroperitoneoscopic partial nephrectomy by using an MTC is a less-invasive procedure for T1a RCC in patients selected by appropriate indication criteria.

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Recently, partial nephrectomy is often selected for the surgical treatment of small renal cell carcinoma (RCC) with its favorable prognosis. To determine the surgical outcomes of partial nephrectomy using a microwave tissue coagulator (MTC), we reviewed our series of 179 patients with 184 T1 RCC who underwent this procedure.
No significant deterioration of the postoperative renal function assessed by serum creatinine and creatinine clearance was observed. The 5-year and 10-year overall survival rates were 96% and 92%, respectively, and the 5-year and 10-year cause-specific survival rates were 99% and 98%, respectively, during the mean follow-up period of 54±43 months. One patient with T1a RCC showed postoperative local recurrence 2 years later.
In conclusion, non-ischemic partial nephrectomy using an MTC is a useful and safe nephron-sparing surgery and is considered as a standard procedure for stage T1a RCC in terms of the oncological outcomes and preservation of the postoperative renal function. Besides, partial nephrectomy is more likely to be indicated extendedly to patients with T1b RCC.

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A 69-year-old female affected of HCV-related cirrhosis in Child-Pugh classification A, developed a solitary hepatocellular carcinoma (HCC), 30mm in diameter. She had undergone laparoscopic microwave coagulation therapy (MCT). At 12 months later, two HCC nodules recurred in the liver were performed MCT and percutaneous ethanol injection therapy (PEIT), respectively. At 11 years later after the initial MCT, a solitary HCC was recurred in the liver again and treated by radiofrequency ablation (RFA). HCV-RNA has been undetectable during all this period. This case has been alive for 12 years after initial treatment.

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Between July 1994 and December 2008, 776 patients received their initial therapy for HCC in our institute. Of these, 18 patients have lived for more than a decade. Microwave coagulo-necrotic therapy (MCN) was performed in 14 patients and hepatic resection (HR) in 4.
These patients were significantly younger (58.5 vs 66.9years old, p = 0.0002) and had a better liver function than the patients who have lived for less than 10 years (especially, serum albumin ; 4.09 vs 3.75, p = 0.0046).
Of 18 patients, 14 patients had recurrences after on average 2,139 post operative days. For these recurrences, MCN was done as much as possible, because according to our last experience, we think that MCN has good efficacy for loco-regional control of HCC, comparable with that of Hr and MCN is especially good at multiple state of HCC and good for the patients with poor liver function. Average times of loco-regional therapy for recurrence were 3.00.
Important feature for the long-term survival of patients with HCC include: preservation of hepatic function and repeating the radical therapy, MCN for initial or recurrent HCC.

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We experienced a 11 year long-term survival case after percutaneous microwave coagulation therapy (PMCT) for hepatocellular carcinoma (HCC). We performed PMCT in 3 lesions, radiofrequency ablation in 6 lesions and percutaneous ethanol injection in 3 lesions during 11 years. Interferon (IFN) therapy was started from 2006, and HCV became negative and liver function improved. We think that early detection of HCC, curative loco-regional treatment of HCC, and IFN therapy were effective for this patient.

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We previously reported an inoperable jaundiced woman and man with bile duct carcinoma who underwent cholangioscopic MTC and survived longer than 13 and 15 years, respectively. Here, we report another jaundiced patient with bile duct carcinoma with survival longer than 10 years after cholangioscopic and X-ray image-guided MTC.
A 56-year-old man was referred to our institution because of right hypochondric pain and constipation with suspected postoperative intestinal stenosis. Three years previously, he had undergone a non-curative resection of carcinoma in the transverse colon, in which both the second group of regional lymph nodes and pelvic tumor were histologically metastatic (Schnitzler's metastasis).
Besides abdominal pain, he had bulbar jaundice, increased serum bilirubin and amylase, and leucocytosis. Percutaneous transhepatic cholangial drainage (PTCD) was performed for biliary decompression with improvement of jaundice, followed by fluorographically complete obstruction of the common bile duct (CBD) suggestive of a neoplastic lesion. Percutaneous transhepatic cholangioscopy (PTCS) revealed a papillary tumor in the terminal portion of the CBD, with a histological diagnosis of papillary adenocarcinoma.
Given his previous non-curative resection of colon cancer, he did not wish to undergo pancreatoduodenectomy (PD) as radical surgery. Therefore, cholangioscopic and X-ray image-guided MTC using Microtaze^® (Heiwa Electronic Industrial Co. Ltd., Osaka Japan), a 1.8 mm φ spherical antenna, and a 5 mm φ bullet-shaped antenna covering a thin guide wire (0.028 inch, Cook Co. Ltd., USA) was carried out under radiation of 45 watts and repetitions of 3-5 seconds in duration.
The patient lived for 11.5 years after the onset of pain and jaundice.
For malignant neoplasms in the early stage of progression in the bile duct, cholangioscopic methods including MTC may be a treatment option aimed at cure, as are bronchoscopic methods for lung cancer in the early stage of progression.

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