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Laparoscopic microwave coagulo-necrotic therapy for hepatocellular carcinoma: a feasible study of an alternative option for poor-risk patients.

In spite of the development of techniques for liver resection, preoperative evaluation of hepatic functional reserve and some other therapeutic options such as transcatheter arterial embolization (TAE) and percutaneous ethanol injection therapy (PEIT), liver failure after surgery is sometimes observed. Some patients, who have small liver cancers (under 2 cm in diameter) are diagnosed by various tests, but hepatic resection is not an option for the subset who have lowered hepatic functional reserve. Conventionally, such cases have been treated by TAE and/or PEIT. For the tumors in segments 7 or 8, as termed by Couinaud, which are located just beneath the diaphragm and are difficult to investigate by ultrasonography (US), or to perform PEIT, we have recently applied laparoscopic microwave coagulo-necrotic therapy (LMCNT) with the guidance of US and in some cases, thoracoscopic MCNT (TMCNT), which is performed across the diaphragm to necrotize the tumor, again with the help of US. Here, we report some cases treated by this technique, and the intraoperative color doppler US, which helps evaluate the effectiveness of MCNT.