Journal of Microwave Surgery
Online ISSN : 1882-210X
Print ISSN : 0917-7728
ISSN-L : 0917-7728
Volume 28
Showing 1-16 articles out of 16 articles from the selected issue
NEWS FEATURE
  • Etsuyo Ogo, Gen Suzuki, Naofumi Hayabuchi
    Type: Review
    2010 Volume 28 Pages 23-27
    Published: 2010
    Released: December 28, 2010
    JOURNALS FREE ACCESS
    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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Interventional Oncology
  • Chiaki Kawamoto, Atsushi Yamauchi, Keiko Kaneko, Naoya Miyagi, Kazuhit ...
    Type: Original
    2010 Volume 28 Pages 39-42
    Published: 2010
    Released: December 28, 2010
    JOURNALS FREE ACCESS
    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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Primary Hepatic Carcinoma
  • Takatoshi Ishiko, Toru Beppu, Akira Chikamoto, Toshiro Masuda, Hirohis ...
    Type: Original
    2010 Volume 28 Pages 47-51
    Published: 2010
    Released: December 28, 2010
    JOURNALS FREE ACCESS
    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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  • Kentaro Nakayama, Masako Ishikawa, Showa Aoki, Kohji Miyazaki
    Type: Original
    2010 Volume 28 Pages 53-56
    Published: 2010
    Released: December 28, 2010
    JOURNALS FREE ACCESS
    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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  • Yasushi Kanaoka
    Type: Original
    2010 Volume 28 Pages 57-60
    Published: 2010
    Released: December 28, 2010
    JOURNALS FREE ACCESS
    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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  • Yasuhiro Yuri, Yuji Takahashi, Kei Omori, Teruaki Kigure, Shigeru Miya ...
    Type: Case Report
    2010 Volume 28 Pages 61-64
    Published: 2010
    Released: December 28, 2010
    JOURNALS FREE ACCESS
    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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  • Nobumichi Tanaka, Kiyohide Fujimoto, Satoshi Anai, Katsuya Aoki, Tatsu ...
    Type: Original
    2010 Volume 28 Pages 65-68
    Published: 2010
    Released: December 28, 2010
    JOURNALS FREE ACCESS
    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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  • Kiyohide Fujimoto, Satoshi Anai, Katsuya Aoki, Tatsuo Yoneda, Nobumich ...
    Type: Original
    2010 Volume 28 Pages 69-74
    Published: 2010
    Released: December 28, 2010
    JOURNALS FREE ACCESS
    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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  • Tamaki Ichiya, Kunihiko Tsuji, Takeshi Matsui, Fukuo Komaba, Jong-Hon ...
    Type: Case Report
    2010 Volume 28 Pages 75-79
    Published: 2010
    Released: December 28, 2010
    JOURNALS FREE ACCESS
    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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  • Yuko Takami, Tomoki Ryu, Yoshiyuki Wada, Hideki Saitsu
    Type: Original
    2010 Volume 28 Pages 81-85
    Published: 2010
    Released: December 28, 2010
    JOURNALS FREE ACCESS
    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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Case Report/Digestive Endoscopy
  • Shigeaki Ino-u-e, Masaaki Endoh, Takashi Fukushima, Toshihiro Nakadate ...
    Type: Case Report
    2010 Volume 28 Pages 91-96
    Published: 2010
    Released: December 28, 2010
    JOURNALS FREE ACCESS
    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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