Journal of Microwave Surgery
Online ISSN : 1882-210X
Print ISSN : 0917-7728
ISSN-L : 0917-7728
Volume 30
Showing 1-39 articles out of 39 articles from the selected issue
NEWS FEATURE
Basic Knowledge
  • Ryan-Z Swan, Victor Tsirline, David Sindram, John-B Martinie, David-A ...
    Type: Review
    2012 Volume 30 Pages 25-40
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    Microwave energy is a unique electromagnetic (EM) energy source for tissue ablation due to optimum size match between EM wavelength and ablation equipment for use in human tissue. This results in the ability to broadcast EM waves at MW frequency from the antenna, as opposed to conducting alternating current from active to dispersive electrode as in radiofrequency ablation (RFA). The EM field surrounding the MW antenna establishes the MW near-field, and the clinically utilized MW frequencies are optimal to effect dielectric heating of biologic tissue within the near-field allowing for intense tissue heating with shortened ablation times as well as a more defined minimum ablation size. Conventional heat transfer still plays a significant role in final ablation size; however, to a lesser extent than seen with RFA. The shape of the MW near-field and the deposition of MW energy into tissue can be modulated by altering the MW antenna design to minimize reflected energy due to impedance mismatch. Given these potential physical advantages over RFA, microwave ablation is becoming increasingly utilized for hepatic and other soft tissue ablation.
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  • Tadatoshi Takayama
    Type: Review
    2012 Volume 30 Pages 41-45
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    The standard strategy in the surgical treatment of hepatocellular carcinoma (HCC) has been outlined based on my experience involving over operated 3,000 cases. My first line operation for HCC is systematic segmentectomy, which carries towards zero mortality and improved survival. Makuuchi′s criteria with bilirubin value and ICG clearance will afford good surgical indication for resection. In living-related liver transplantation, patients with HCC meeting Milan criteria are good candidates. In this review, I will show the surgical treatment options currently available for patients with HCC.
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  • Kazuhiro Kasai, Kazuyuki Suzuki
    Type: Review
    2012 Volume 30 Pages 47-52
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    This review described clinical development of chemotherapy for advanced hepatocellular carcinoma. We showed the efficacy of combined 5-fluorouracil (5-FU) and pegylated interferon (PEG-IFN) α-2b in patients with advanced HCC. Furthermore, we reviewed the treatment of sorafenib for patients with advanced HCC, and showed the efficacy of sorafenib for patients with advanced HCC in our institution.
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Cholangioscopic microwave Coagulation Therapy
  • Yasushi Kanaoka, Hirosumi Imoto
    Type: Original
    2012 Volume 30 Pages 61-65
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    Objectives: Transcervical microwave adenomyolysis (TCMAM) along with microwave endometrial ablation (MEA) could replace hysterectomy for treating adenomyosis. Thus, we performed a feasibility study in the treatment of adenomyosis by simultaneously using TCMAM and MEA.
    Materials and methods: Two adenomyosis patients with menorrhagia and dysmenorrhea who selected MEA as an alternative to hysterectomy were recruited to the study. After MEA was performed, a 4-mm microwave applicator with a conic end was transcervically introduced, under transabdominal ultrasound guidance, into the uterine cavity and inserted into the adenomyosis.
    Results: We observed improvement in menorrhagia and dysmenorrhea in the patients, a de novo necrotized area in a uterus visualized by contrast enhanced MRI shrank at 3 months after the operation.
    Conclusion: TCMAM along with MEA is a possible alternative to hysterectomy for treating adenomyosis.
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  • Kentaro Nakayama, Tomoka Ishibashi, Hiroshi Katagiri, Atsuko Katagiri, ...
    Type: Original
    2012 Volume 30 Pages 67-70
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    We evaluated the effectiveness of microwave endometrial ablation (MEA) for the emergent control of life-threatening uterine bleeding. Seventeen patients received emergency MEA. Twelve out of seventeen patients were treated with MEA as their primary procedure, and five out of seventeen patients were treated for an intraoperative uterine bleeding. In all twelve patients treated preoperatively, MEA was highly effective and successfully controlled acute uterine bleeding. Five out of seventeen patients were treated with MEA for a bleeding following resection of a submucosal myoma or polyp. MEA successfully controlled bleeding in all five patients, thereby preventing them from undergoing hysterectomy. Current findings suggest that emergency MEA is a promising way to control a life threatening uterine bleeding.
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  • Akira Tsuda
    Type: Original
    2012 Volume 30 Pages 71-75
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    The aim of the study is to evaluate the safety and effectiveness of microwave endometrial ablation (MEA) in women with menorrhagia for office-based gynecology. Twenty five outpatients (average age 45.2) who hoped to avoid hysterectomy received MEA for treatment of menorrhagia. The mean operation time was 14.7 (7-54) min. The blood loss during a monthly menstrual period decreased in 22 women (88%) to less than 20%, 2 (8%) to less than 50%. Menorrhagia remained in 1 patient (4%) of the 25 women after MEA. Six patients (24%) felt nausea and 1 (4%) had diarrhea within 12 hours post-ablation. Three patients (12.0%) had mild endometritis after treatment. The average VAS score regarding feelings of satisfaction for MEA was 8.5 (full score=10). MEA for menorrhagia is feasible and safe, and an easy and fast in-office day surgical procedure that is minimally invasive for who hoped to avoid hysterectomy.
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  • Yasuhiro Yuri, Teruaki Kigure, Kouki Nakata
    Type: Original
    2012 Volume 30 Pages 83-86
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    We have performed transurethral microwave tissue coagulation (MTC) for urinary bladder cancer, and especially applied MTC to small tumors of outpatients without anesthesia. In this report, flexible MTC (f-MTC) with a flexible cystoscope was performed. Ten patients of recurrent bladder cancer were treated. The tumor gradings were G1 and G2 in 4 and 6 cases. Six cases had solitary tumor and 4 cases had multiple tumors. In 8 cases, tumors were up to 3 mm in diameter, and 2 cases had tumors over 5 mm. Recurrence occurred in 3 cases. One case was followed by TUR-Bt and 2 cases were followed by f-MTC. This procedure is less painful and it can be performed immediately after cystoscopy. It was useful in the treatment of small bladder cancer.
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  • Mio Onodera, Hidekatsu Kuroda, Takayoshi Oikawa, Akira Ushio, Yasuhiro ...
    Type: Original
    2012 Volume 30 Pages 87-90
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    Radiofrequency ablation (RFA) has been widely used as a therapeutic method for hepatocellular carcinoma. RFA has been also used for metastatic liver cancer to reduce tumor mass. Here, we describe the result of RFA therapy for metastatic liver cancer in our institution. As a result, RFA is feasible in the majority of the metastatic liver cancer cases who cannot be treated by surgical resection. In the near future, RFA may be one of the important options for the treatment of metastatic liver cancer in the near future.
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  • Yuko Takami, Masaki Tateishi, Tomoki Ryu, Yoshiyuki Wada, Hideki Saits ...
    Type: Original
    2012 Volume 30 Pages 91-96
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    From July 1994 to December 2011, we have surgically treated 27 cases with liver metastases from breast cancer. Resection and/or microwave coagulo-necrotic therapy (MCN) were performed. After these operations, chemotherapy and/or endocrine therapy were also given to the patients. The 1, 3, and 5-year survival rates of all patients after first liver surgical treatment were 96.3%, 61.8%, and 53.0%.
    In general, metastases of breast cancer to the liver are uncommonly indicated surgical treatment. But recently we encounter some reports that liver resection is a useful procedure to improve the poor prognosis of liver metastases of mammary origin. From these literatures and our experience, we believe that surgical treatments as reduction surgery should be one of the beneficial options for metastases to the liver from breast cancer. In particular, MCN is a useful procedure for multiple liver metastases.
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  • Tomoki Ryu, Yuko Takami, Masaki Tateishi, Yoshiyuki Wada, Hideki Saits ...
    Type: Original
    2012 Volume 30 Pages 97-102
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    We evaluated the effect of hepatic surgery, including microwave coagulo-necrotic therapy (MCN), for liver metastases from gastric cancer. Twenty-nine patients with gastric liver metastases underwent hepatic surgery in our institute between December 1997 and December 2011. Hepatic resection (HR) was performed in 13 patients, MCN in 9, and MCN in combination with HR in 7. The overall survival rates at 1-, 3-, and 5-years were 83.8%, 37.3%, and 31.1%, respectively. Five patients have survived with no recurrence for more than 5 years. One of the patients treated with MCN for 7 gastric liver metastases. In conclusion, MCN alone or MCN in combination with HR allow more patients with gastric liver metastases to become candidates for hepatic surgery and give the long-term survival.
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Metastatic Hepatic Carcinoma, Ablation
  • Yoshiyuki Wada, Yuko Takami, Masaki Tateishi, Tomoki Ryu, Hideki Saits ...
    Type: Original
    2012 Volume 30 Pages 103-108
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    Background: Techniques of microwave coagulo-necrotic therapy (MCN) for colorectal liver metastases (CRLM) have been revised in recent years. This retrospective study investigated the efficacy of MCN in the treatment of CRLM and determined the indications for MCN use in cases with CRLM.
    Materials and Methods: This study involved 243 patients with CRLM who underwent hepatic resection (HR) (n = 79),MCN (n = 111), or HR + MCN (n = 53) at our institution. Five-year survival was compared between the 3 groups of patients.Local control with MCN was assessed by investigation of local recurrence rates.
    Results: Overall 5-year survival rates of HR-, MCN-, and HR + MCN-treated cases were 45.9%, 40.0%, and 36.6%, respectively; the difference was not statistically significant. Furthermore, there was no significant difference in disease-free survival between the 3 procedures. Local recurrence was observed in 12 of the 111 MCN-treated cases. Tumor diameter >20 mm was identified as a significant predictor of increased local recurrence. MCN-related complications were associated with tumors >30 mm in diameter, irrespective of location.
    Conclusion: Tumor diameter ≤20 mm can be used as the adaptive criterion for MCN of deep hepatic lesions, whereas tumor diameter ≤30 mm should be the adaptive criterion for MCN of superficial lesions.
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Hepatocellular Carcinoma, Ablation
  • Toru Beppu, Takatoshi Ishiko, Akira Chikamoto, Hirohisa Okabe, Katsuno ...
    Type: Review
    2012 Volume 30 Pages 109-117
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    Thermal ablation; radiofrequency ablation (RFA) and microwave coagulation therapy (MCT) has spread widely as a less invasive and curative treatment for hepatocellular carcinoma (HCC). "Thermal ablation program in Kumamoto University" has been continued for over 20 years. From 1994 to 2010, thermal ablation was applied for 807 HCC patients; percutaneous, endoscopic and open ablation were applied for 420 patients (52%), 298 (37%) and 89 (11%), respectively. Long-term survival was excellent; 3-, 5-, and 10-year cumulative overall survival rates were 68%, 52% and 29%, respectively. In contrast, there observed some adverse events in thermal ablation mainly in the early period. Complication rates in 200 MCT and 230 RFA were 10% and 5%, respectively. In this paper, we introduced several complications and its management and preventive method Thermal ablation has a dark side of providing severe complications for a couple of patients, therefore observance of strict indication is always required.
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  • Chiaki Kawamoto, Atsushi Yamauchi, Keiko Kaneko, Akiko Miyamoto, Shuji ...
    Type: Original
    2012 Volume 30 Pages 119-123
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    Background: Some of the unexpected recurrence observed after radiofrequency ablation (RFA) might be caused by increased intratumoral pressure. The present study examined the relationship between RFA and intratumoral pressure.
    Subjects and Methods: Thirty-two patients with a mean tumor size of 14.7 ± 1.1 mm were studied. A LeVeen needle electrode was used for RFA. Intratumoral pressure was monitored using an invasive blood pressure monitor. RFA was performed with multi-step method (The array was deployed in 8 steps according to tumor size. At each step, the power was fixed at 30 W until power roll-off).
    Results: Intratumoral pressure was measured easily and safely in all cases. Mean maximum intratumoral pressure was as follows: 4/8 expansion, 38.6 ± 25.9 mmHg; 6/8 expansion, 38.0 ± 32.1 mmHg; and complete (8/8) expansion, 39.1 ± 28.7 mmHg. The multi-step method allowed suppression of increases in intratumoral pressure. The patients did not experience much pain during RFA.
    Conclusions: The intratumoral pressure measurement that we employed is relatively easy and is suited for monitoring pressure during RFA.
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  • Hidekatsu Kuroda, Takayoshi Oikawa, Mio Onodera, Yoshinori Tatemichi, ...
    Type: Original
    2012 Volume 30 Pages 125-128
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    Objective: Contrast-enhanced computed tomography (CECT) is regarded as the gold standard for assessing the efficacy of radiofrequency ablation (RFA) against hepatocellular carcinoma (HCC). We evaluated the efficacy of Fusion Imaging combining contrast-enhanced ultrasonography (CEUS) with three-dimensional ultrasonography (3DUS) vs CECT for assessing the ablative margin after RFA.
    Materials and Methods: The therapeutic responses in 5 patients with 7 HCC nodules were assessed by Fusion Imaging combining CEUS with 3DUS as well as by CECT. The efficacy of treatment was based on whether the safety margin was greater than 5 mm after RFA.
    Results: Of the 7 nodules, 6 had sufficient safety margins on Fusion Imaging combining CEUS with 3DUS. This was the same result as evaluation by CECT.
    Conclusion: Fusion Imaging combining CEUS with 3DUS is effective in assessing the ablative margin after RFA for HCC.
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  • Yasushi Hasegawa, Hiroyuki Nitta, Akira Sasaki, Takeshi Takahara, Masa ...
    Type: Review
    2012 Volume 30 Pages 129-132
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    Laparoscopic liver resection is becoming increasingly popular, but its application remains limited to a few institutions. Laparoscopic hepatectomies began to be performed at Iwate Medical University Hospital in May 1997. From then to February 2012, 138 patients underwent pure laparoscopic liver resection and 141patients were treated with a hybrid technique. In some cases, precoagulation technique was performed prior to parenchymal transection for hemostasis. Then, the liver parenchyma was transected mainly by the use of CUSA and Salient Endo SH2.0. Precoagulation technique with radio frequency ablation was one of the efficient methods for hemostasis.
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  • Akishige Kanazawa, Tadashi Tsukamoto, Sadatoshi Shimizu, Shintaro Koda ...
    Type: Review
    2012 Volume 30 Pages 133-138
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    Although laparoscopic liver resection has been gradually accepted as a treatment of choice for benign and malignant hepatic diseases, it is necessary to use effective hemostatic device to safety enlarge the indications of laparoscopic liver resection. We have been expanded the use of laparoscopic liver resection by selecting effective hemostatic device: microwave pre-coagulation and soft-coagulation system. In the laparoscopic limited liver resection for the patient with severe liver cirrhosis, we usually use pre-coagulation technique with Microtaze® to control bleeding from the cirrhotic liver. On the other hand, in the laparoscopic anatomical liver resection of non-cirrhotic liver, we use Sonosurg® for the surface of the liver and laparoscopic surgical aspirator and monopolar forceps using soft-coagulation with saline dripping. Selecting proper hemostatic devices based on the conditions of liver is important for safe laparoscopic liver resection.
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  • Yuichiro Otsuka, Yoshihisa Kubota, Jun Ishii, Tetsuya Maeda, Toshio Ka ...
    Type: Original
    2012 Volume 30 Pages 139-143
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    Application of surgical instruments is an important issue to achieve safe laparoscopic hepatectomy (LH) and further development of minimally invasive surgery. EnSeal® (Ethicon Endo-Surgery, LLC, Cincinnati, OH, USA) is a bipolar tissue sealing device that includes a blade for tissue division. We have used EnSeal® in 22 LHs for 15 patients who had primary or metastatic liver tumor. Procedures of LH were pure laparoscopic procedures in 16 (2 anatomical resections except left lateral sectionectomy, 4 left lateral sectionectomies, 10 partial resections), hand assisted procedure in 4 (4 partial resections) and laparoscopy assisted procedure in 2 (2 partial resections). Mean operative duration was 371.1 minutes, and mean blood loss was 291.5 cc. Average number of clips used was 2.0. However, no clips were used in 63.6% of LHs (14 LHs; 3 left lateral sectionectomies, 11 partial hepatectomies). The average postoperative hospital stay was 7.2 days. No morbidity including bile leakage, or mortality was found. LH using EnSeal® is safe, and can contribute to reducing the usage of surgical clip.
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  • Takeshi Aoki, Masahiko Murakami, Yuta Enami, Reiko Koike, Akira Fujimo ...
    Type: Review
    2012 Volume 30 Pages 145-149
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    We demonstrated here a bloodless liver parenchymal transection using a bipolar radiofrequency device in video assisted thoracoscopic surgery-hepatectomy (VATS-H) and laparoscopic hepatectomy (LH). The laparoscopic Habib 4X is a bipolar radiofrequency device consisting of a 2 × 2 array of needles arranged in a rectangle. It enables bloodless transection of the liver parenchyma. Thirty-three laparoscopic liver resections were performed with Habib 4X for liver neoplasm. Pringle manoeuvre was not used in series of VATS-H and pure-LH. The average blood loss was less than 152 mL. None of the patients had postoperative complication, such as postoperative bleeding and biliary leakage from liver transection area.
    Laparoscopic liver resection using Habib 4X can be safely performed with a minimum intraoperative bleeding or postoperative complication.
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  • Masaru Tsuchiya, Yuichiro Otsuka, Tetsuya Maeda, Jun Ishii, Yoshihisa ...
    Type: Case Report
    2012 Volume 30 Pages 151-155
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    We report a case of the laparoscopic hepatectomy for ruptured hepatocellular carcinoma (HCC) controlled after transcatheter arterial embolization (TAE). The patient was 70 year-old-male who had underwent laparoscopy-assisted distal gastrectomy for early gastric cancer 7 years ago, and visited the emergency department because of shock. An abdominal CT scan revealed a ruptured tumor in S6 of liver. Emergency TAE achieved successfully hemostasis. Elective laparoscopic hepatectomy (LH) was performeded on day 40 after TAE. HALS was used to obtain the sufficient surgical margin and to release intra-abdominal adhesions safely. The liver parenchyma was transected using microwave tissue coagulator and salient monopolar sealer for precoagulation. The patient discharged from hospital at POD7 without morbidity. We suggest LH could be one of the options for staged hepatectomy of the ruptured HCC, in properly selected patients.
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Liver Resection Technology
  • Shoji Kubo, Shigekazu Takemura, Takahiro Uenishi, Chikaharu Sakata, Ka ...
    Type: Original
    2012 Volume 30 Pages 159-162
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    In order to evaluate the effects of microwave tissue coagulation (MTC) on postoperative complications, the number of incidences of postoperative bleeding, bile leakage, intraabdominal infection, wound infection, and intractable pleural effusion and ascites were compared between 142 patients who underwent liver resection using MTC (MTC group) and 60 other patients (non-MTC group). The liver was coagulated with a microwave tissue coagulator along the resection line by puncture of the needle applicator (15-mm length) before the transection of the liver. MTC was not used near the thick Glisson′s sheath, major hepatic veins, or the hepatic hilum in order to prevent injury to major vessels or bile ducts. There were no differences in the number of incidences of these complications between the groups. In addition, there were no differences in the characteristics of the bacteria isolated between the groups. Thus, MTC does not affect the development of postoperative complications in liver resections when MTC is used appropriately.
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Cholangioscopic Technology
  • Shigeaki Ino-u-e, Masaaki Endoh, Takashi Fukushima, Takao Itoh, Shoich ...
    Type: Review
    2012 Volume 30 Pages 163-170
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    We have tried to make use of a microwave generator (Microtaze® for hepatectomy, Heiwa Electrics Co., Ltd. Osaka Japan) to experimentally and clinically break calcium bilirubinate stones, and coagulate tumors in the bile duct. Treatments such as to break stones and coagulate tumors in the bile duct are called as Microwave lithotomy and Percutaneous Transhepatic Cholangioscopic Microwave Tissue Coagulation (PTCS-MTC), respectively.
    Concerning Microwave lithotomy, our task is to make a cable with a lower capacity to maximize the efficiency of microwave lithotomy.
    And, as for neoplasms, PTCS-MTC may be useful for palliation of inoperable patients with bile duct cancer, and for cure of the patients in the early stage of progression.
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Thoracoscopic Technology
  • Takahiko Oyama, Tetsushi Suito, Hiroyuki Fujimoto, Manabu Yamamoto, Yo ...
    Type: Review
    2012 Volume 30 Pages 171-174
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    Ovjectives and subjects: The subjects were 70 patients who underwent endoscopic microwave coagulation therapy in Ashikaga Red Cross Hospital between January 2001 and December 2010. They were classified into the four categories below, and the usefulness of therapy and treatment limitations were evaluated:
    1. Malignant airway stenosis
    2. Benign airway stenosis
    3. Radical ablation for early stage central lung cancer
    4. Coagulation therapy for visible bleeding
    Results: Of the subjects, 56 had malignant airway stenosis, 11 benign airway stenosis, 1 early stage central lung cancer, and two had visible bleeding.
    Conclusion: Cases treatable with endoscopic microwave coagulation therapy alone are limited regardless of whether malignant or benign, and such therapy is conducted before or after surgery or other endoscopic treatments. It was considered that, in adjunctive local therapy aimed at improving ventilator impairment and controlling bleeding, endoscopic microwave coagulation therapy is useful to relieve dyspnea and improve the QOL.
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GI Endoscopic Technology
  • - Numerical calculations and animal experiment -
    Koichi Ito, Kazuyuki Saito
    Type: Review
    2012 Volume 30 Pages 175-181
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    Up to now, the authors have been studying various thin antennas for microwave thermal therapies. Especially, a coaxial-slot antenna aiming at intracavitary heating for bile duct carcinoma has been developed. In this paper, first, heating performances of the antenna are estimated by use of numerical calculations. Moreover, temperature rise around the antenna, which is inserted into the bile duct, are measured using the living swine to find a cooling effect of blood flow. As a result of the investigations, the possibility of this treatment by use of the coaxial-slot antenna could be confirmed.
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MR Image-guided Technology
  • -From a simple spacer to a motorized robot-
    Shigehiro Morikawa, Shigeyuki Naka, Hisanori Shiomi, Hiroyuki Murayama ...
    Type: Review
    2012 Volume 30 Pages 183-190
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    In MR-guided microwave ablation of liver tumors, real-time MR images including the needle path and the target tumors were essential for accurate puncture. An optical tracking system, integrated in the MR system, played a very important role for the interactive scan plane control. The optical tracking system, however, had some limitations caused by the line of sight between the LEDs and detectors. In addition, the LEDs were slightly ferromagnetic. To solve the problems of this tracking system, we prepared various adaptors for the hand piece. Then, we procured less magnetic LEDs with compatible performance and created new original hand pieces. A hybrid tracking system with optical and electromagnetic detections was also constructed and seamless navigation was enabled. Finally, an MR-compatible motorized robot was developed to chase the preset target point automatically. With these devices to track the target, more convenient and accurate puncture of liver tumor was realized under MR image guidance.
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Laparoscopic Technology
  • Yuta Minami, Hidenobu Masui, Mitsutaka Sugita, Ryo Takagawa, Kazutaka ...
    Type: Review
    2012 Volume 30 Pages 191-194
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    Background/Purpose: The purpose of this study was to evaluate the efficacy of laparoscopy-assisted liver surgery, to introduce laparoscopic surgery for hepatectomy.
    Operative procedure: After the mobilization of the liver under the laparoscope, hepatectomy was performed through the small skin incision as the same procedure as the conventional hepatectomy without the laparoscope.
    Method: Between 2009 and Jun. 2011, 31 patients underwent laparoscopy-assisted hepatectomy (Laparoscopic group). Twenty-seven patients who underwent conventional hepatectomy under wide incision without laparoscope were control as a matched group (Open group). Operation time, operative blood loss, total amount of transfusion and the short term outcome were compared.
    Result: Operating time in the laparoscopy group was significantly longer than that of the open group. There were no significant differences in other operating factor and postoperative complications. Short term outcomes was not significantly different because of the same clinical pathways in both groups.
    Conclusion: Laparoscopy-assisted hepatectomy is feasible and well tolerated. It seemed to be minimal invasive and useful as the early stage of the introduction of laparoscopic surgery for hepatectomy.
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Percutaneous Technology
  • Akihiro Sawamura, Takaoki Furukawa, Hideki Inoue, Takashi Iwata, Kazum ...
    Type: Review
    2012 Volume 30 Pages 195-199
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    Merits of percutaneous low output microwave tissue coagulation therapy (PLMCT) is following that coagulation area is distinctly observed by ultra-sonography, because of no bubbling through irradiation. PLMCT can be performed under local anesthesia. Size of coagulation area by PLMCT and high output PMCT are the same.
    The possible use of PLMCT using ultra-sonography under local anesthesia for small solitary recurrent or metastatic liver cancer was studied.
    The subjects were 19 patients having recurrent or metastatic liver cancer with solitary liver tumor less than 4 cm in diameter between September 1994 and July 2010.
    No tumor recurrence was recognized in the coagulation area. Thus, the results suggest that PLMCT is a useful therapy for small solitary liver cancer especially, recurrence of hepatocellular carcinoma as a local control.
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Thermal Ablation Technology
  • Akira Chikamoto, Toru Beppu, Yuji Miyamoto, Masayuki Watanabe, Takatos ...
    Type: Review
    2012 Volume 30 Pages 201-206
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    We reviewed the clinical efficacy of thermal ablation for colorectal liver metastasis (CRLM). Microwave coagulation therapy (MCT) has advantages in intraoperative use in selected cases. Five-year overall survival after MCT for CRLM ranged from 20% to 32%. However, all reports were published before oxaliplatin or irinotecan based regimen with or without targeted agents come on the scene. The three- and five-year survival rates of radiofrequency ablation (RFA) alone for CRLM ranged from 42% to 57%, and 21% to 37%, respectively. The 5-year survivals rates after RFA with perioperative chemotherapy ranged from15% to 30%. The local recurrence rate at the RFA site varied from 16 to 60%. The 3- and 5-year survival rates of RFA in combination with hepatic resection ranged from 38% to 47%, and 47% to 68%, respectively. The rate of local recurrence was between 5 and 17.4%. In this era of new chemotherapy, thermal ablation could improve the outcome in combination with chemotherapy and/or liver resection.
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Thoracoscopic Technology
  • Takatoshi Ishiko, Toru Beppu, Akira Chikamoto, Kouichi Doi, Hirohisa O ...
    Type: Review
    2012 Volume 30 Pages 207-211
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    Aim: To assess the feasibility and usefulness of thoracoscopic radiofrequency ablation (TRFA) for hepatocellular carcinoma (HCC).
    Background: HCC located below the diaphragmatic dome remains one of the poorly treatable tumors for percutaneous ablation therapy. TRFA has been proposed as a technique of choice for those tumors.
    Patients and Methods: Between January 2000 and December 2010, 92 patients who suffered from HCC under the diaphragm were indicated for local ablation therapy. The thoracoscopic approach was required for accurate and safe ablation procedures.
    Results: The surgical procedures consisted of thoracoscopic radiofrequency ablation with endoscopic ultra-sonography. All patients recovered and were eventually discharged. Postoperative mortality rate was 0%. The overall and disease-free 5-years survival rates of TRFA were 51.9% and 7.1%, respectively.
    Conclusion: TRFA is recommended as an effective and feasible treatment for the HCC located under the diaphragm.
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Laparoscopic Technology
  • Jun Ishii, Yuichiro Otsuka, Masaru Tsuchiya, Yoshihisa Kubota, Toshio ...
    Type: Review
    2012 Volume 30 Pages 213-217
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    Laparoscopic hepatectomy has not been widely accepted, and has only been performed at special centers in 1990s, due to difficulties in technique and control of bleeding. In the last decade, multiple series have reported that laparoscopic hepatectomy is safe and efficacious. Moreover, recent experience has persuaded us that there are great potential benefits derived from laparoscopic hepatectomy, and we learned much regarding patient selection, the grade of surgical difficulty according to tumor location and the required instrumentation. To minimize blood loss, a precoagulation technique was applied in which the resection line is diathermically coagulated before liver parenchymal transection. In this technique, laparoscopic microwave tissue coagulator is useful for the precoagulation on superficial layer of liver, especially in cirrhotic patients. Laparoscopic liver resection appears to be a viable surgical alternative as less invasive surgery in selected cases with appropriate application of surgical instruments.
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  • Hiroya Iida, Tsukasa Aihara, Shinichi Ikuta, Hidenori Yoshie, Ryo Okam ...
    Type: Review
    2012 Volume 30 Pages 219-223
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    Percutaneous ablation therapy has been widely used for the treatment of hepatocellular carcinoma. However, choice of approach needs to be made with a careful consideration on the tumor location. We report a case of 62-year-old male who had been initially treated for hepatitis C by a general practitioner. In June 2006, since hepatocellular carcinoma 15 mm in diameter was detected by ultrasound, located in segment 5 adjacent to gallbladder, the patient was referred to our hospital. In this case, we firstly performed transcatheter arterial embolization. After seven days, we performed laparoscopic cholecystectomy in combination with additional laparoscopic microwave coagulation following percutaneous radiofrequency ablation. Complete ablation of the tumor was obtained. Notably, viable carcinoma cells were found in the resected gallbladder specimen.
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Laparoscopic and Thoracoscopic Technology
  • Koichi Doi, Toru Beppu, Takatoshi Ishiko, Akira Chikamoto, Toshiro Mas ...
    Type: Review
    2012 Volume 30 Pages 225-230
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    The optimal treatment for hepatocellular carcinoma (HCC) is surgical resection, however operative candidates are limited. Thermal ablation for small HCC is less invasive and effective therapy. Thermal ablation with endoscopy is highly recommended for contraindicative patients for percutaneous thermal ablation therapy, such as lesions located at surface of the liver or adjacent to the gallbladder, digestive organs, bile duct and heart.
    In this review, we summarized the published English literatures including the study with endoscopic microwave coagulation therapy (MCT) and radiofrequency ablation (RFA) for HCC. Survival outcome and complication of thermal ablation are presented and discussed.
    In conclusion, endoscopic thermal ablation has progressed with devices and is safe and feasible treatment modality in selected patients with unresectable HCC that are not suitable for the percutaneous approach.
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Transurethral Technology
  • Teruaki Kigure, Kouki Nakata, Yasuhiro Yuri, Tadashi Harada, Shigeru M ...
    Type: Review
    2012 Volume 30 Pages 231-237
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    The purpose of this article is to review the literature dealing with microwave therapy for the treatment of bladder cancer. Various studies reviewed in this article indicated that microwave delivering devices enabled the application of local hyperthermia and coagulation therapy to treat several superficial or deep bladder cancers. The authors conclude that microwave local hyperthermia in combination with intravesical chemotherapy seems to be efficacious for patients with superficial bladder cancer and bacillus Calmette-Guerin failures, and, as the various studies suggest, transurethral microwave tissue coagulation seems to be feasible and promising as a minimally-invasive treatment for patients with superficial and deep bladder cancers. However, the use of a combined-modality treatment as an alternative to radical cystectomy remains under investigation.
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  • Teruaki Kigure, Kouki Nakata, Yasuhiro Yuri, Tadashi Harada, Shigeru M ...
    Type: Review
    2012 Volume 30 Pages 239-245
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    For many years, transurethral resection of the prostate (TURP) has been the definitive treatment for benign prostatic hyperplasia (BPH). However, TURP is considered rather invasive because about 20% of the patients develop significant complications within 10 years. With the development of microwave technology, minimally invasive procedures have been introduced in an attempt to decrease the morbidity experienced with TURP. Various studies reviewed in this article indicate that the outcome of microwave heat therapy for BPH and prostatic cancer is encouraging although further research is required to evaluate the long-term effectiveness and safety of this therapy. The authors conclude that, as microwave technologies improve in the near future, increased clinical utilization of this exciting method is expected.
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Percutaneous Technology
  • Hideo Fukuhara, Keiji Inoue, Takashi Karashima, Taro Shuin
    Type: Review
    2012 Volume 30 Pages 247-251
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    Purpose Percutaneous radiofrequency ablation for renal tumor could be a useful modality as minimally invasive and palliative therapy. In this study we evaluated their feasibility and safety.
    Methods Between 2004 and 2011, real-time CT guided radiofrequency ablation was perfomed to ablate a total of 16 tumors in 13 patients. We recorded whether tumors were successfully ablated, major complications and changes of creatinine clearance before and after RFA.
    Results Overall 11 of 13 (84.6%) were successfully ablated with radiofrequency ablation but 2 had local recurrent tumors. There was no significant change in creatinine clearance between before and after RFA. Two minor complications as pararenal hemorrhage were observed.
    Conclusion Percutaneous radiofrequency is a feasible and safe modality as a minimally invasive therapy.
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MEA
  • Masahiko Ishikawa, Kayo Katayama, Hiroshi Yoshida, Fumiki Hirahara
    Type: Review
    2012 Volume 30 Pages 253-257
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    Objective: Microwave endometrial ablation (MEA) with a 2.45 GHz microwave was first in Japan performed to treat intractable menorrhagia by Kanaoka et al. in 1998. Since then satisfactory results have been reported. The present study was conducted to assess symptomatic rating improvements, complication statuses and evidence of no recurrence after surgery.
    Methods: MEA was performed on 30-51-year-old patients with complaint of menorrhagia (52 patients) or prolonged menstruation (3 patients). Postoperative findings were evaluated, including subjective symptoms, hematological improvement ratings and complication statuses, with periodic ambulatory follow-ups for recurrences and complications. Also studied were patients with complicating dysmenorrhea.
    Results: All 52 patients with menorrhagia achieved amelioration of their subjective symptoms; in 92.2% of treated cases, anemia treatment became no longer necessary. All 3 patients with prolonged menstruation achieved remarkable amelioration. In all patients who experienced recurrent menorrhagia requiring treatment after surgery, the recurrence was within 6 months and no patients were experienced recurrent disease beyond 6 months after surgery. One patient experienced pyosalpinx one month after surgery; she underwent hysterectomy and salpingooophorectomy. In three other patients, endometrial cytology was not available, due to cavity adhesion; however, no other severe complications were observed. Effective amelioration of dysmenorrhea was obteined in 94.7% (18/19) of the patients without complicating adenomyosis uteri, but the ratio was low, at 66.7% (12/18), in the patients with complicating adenomyosis uteri.
    Conclusion: MEA is potentially a safe and highly effective surgical procedures for menorrhagia, when performed taking into account its technical features, indications and complications. It seems necessary to follow the course for at least six months after surgery.
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  • Yasushi Kanaoka
    Type: Review
    2012 Volume 30 Pages 259-263
    Published: 2012
    Released: January 29, 2013
    JOURNALS FREE ACCESS
    Microwave endometrial ablation at 2.45 GHz using a thin, curved microwave applicator for organic menorrhagia was developed more than 10 years ago. Since then, the number of patients who undergo this treatment has been gradually increasing. Additionally, various clinical applications of microwave ablation to gynecologic lesions, including direct microwave ablation therapy for myoma and adenomyosis, is occasionally conducted. Other techniques include transcervical microwave myolysis for uterine myomas and transcervical microwave adenomyolysis for uterine adenomyosis combined with microwave endometrial ablation. Necrosis followed by shrinkage of myomas and adenomyosis after microwave ablation therapy has been observed in a pilot study. Microwave endometrial ablation as an alternative to hysterectomy appears to be a logical choice for treating noninvasive endometrial cancer and atypical endometrial hyperplasia when the patient is a poor surgical candidate.
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