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Intraoperative Triple Antenna Hepatic Microwave Ablation

¹ Department of Diagnostic Imaging, Brown Medical School, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903.
² Department of Surgery, Brown Medical School, Rhode Island Hospital, Providence, RI.
³ Department of Diagnostic Imaging, David Geffen School of Medicine at UCLA, Los Angeles, CA.
⁴ Department of Pathology, Brown Medical School, Rhode Island Hospital, Providence, RI.
⁵ Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
⁶ Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA.

View larger version (8K): [in a new window]   Fig. 1 —Photograph shows single straight microwave antenna (VivaTip Surgical, Vivant Medical) with 3.6-cm active tip.

View larger version (123K): [in a new window]   Fig. 2 —Digital photograph of 48-year-old woman with colorectal carcinoma metastases taken intraoperatively shows insertion of three single microwave antennas (VivaWave Microwave Coagulation System, Vivant Medical) spaced 2.0 cm apart using rigid spacer.

View larger version (144K): [in a new window]   Fig. 3A —48-year-old woman with colorectal carcinoma metastases (patient 1 in Table 1). Sequential sonograms (taken 1-2 minutes apart) show development of exuberant transient hyperechogenic response in surrounding liver parenchyma to microwave ablation.

View larger version (157K): [in a new window]   Fig. 3B —48-year-old woman with colorectal carcinoma metastases (patient 1 in Table 1). Sequential sonograms (taken 1-2 minutes apart) show development of exuberant transient hyperechogenic response in surrounding liver parenchyma to microwave ablation.

View larger version (164K): [in a new window]   Fig. 3C —48-year-old woman with colorectal carcinoma metastases (patient 1 in Table 1). Sequential sonograms (taken 1-2 minutes apart) show development of exuberant transient hyperechogenic response in surrounding liver parenchyma to microwave ablation.

View larger version (127K): [in a new window]   Fig. 4 —Scaled digital photograph taken of resected gross specimen from a 67-year-old man with colorectal carcinoma metastases (patient 6 in Table 1) shows ablation zone extending to hepatic vein (large arrow). Three microwave antenna sites (small arrows) are seen in center of ablation zone. Note central pale zone of coagulation surrounded by red hyperemic zone.

View larger version (213K): [in a new window]   Fig. 5A —Photomicrographs of colorectal carcinoma (CRC) metastases to liver and of normal liver. Photomicrographs of same sections of liver from 54-year-old man (patient 2 in Table 1) with CRC metastases stained with H and E stain (A) and vital histochemical nicotinamide adenine dinucleotide (NADH) stain (B) show complete microwave thermocoagulation of all areas (magnification, x100). Note this effect is more clearly seen on NADH-stained slide (B).

View larger version (165K): [in a new window]   Fig. 5B —Photomicrographs of colorectal carcinoma (CRC) metastases to liver and of normal liver. Photomicrographs of same sections of liver from 54-year-old man (patient 2 in Table 1) with CRC metastases stained with H and E stain (A) and vital histochemical nicotinamide adenine dinucleotide (NADH) stain (B) show complete microwave thermocoagulation of all areas (magnification, x100). Note this effect is more clearly seen on NADH-stained slide (B).

View larger version (204K): [in a new window]   Fig. 5C —Photomicrographs of colorectal carcinoma (CRC) metastases to liver and of normal liver. For comparison with A and B, photomicrographs of sections from same patient of normal liver parenchyma obtained after microwave ablation and stained with H and E (C) and NADH (D) stains show complete thermocoagulation on left half of slide but viable tissue on right (magnification, x100). Note dark blue area (viable cells) on right is more evident on NADH-stained slide (D).

View larger version (191K): [in a new window]   Fig. 5D —Photomicrographs of colorectal carcinoma (CRC) metastases to liver and of normal liver. For comparison with A and B, photomicrographs of sections from same patient of normal liver parenchyma obtained after microwave ablation and stained with H and E (C) and NADH (D) stains show complete thermocoagulation on left half of slide but viable tissue on right (magnification, x100). Note dark blue area (viable cells) on right is more evident on NADH-stained slide (D).

View larger version (127K): [in a new window]   Fig. 6 —Digital photograph of resected gross specimen from a 67-year-old man with colorectal carcinoma metastases (patient 8 in Table 1) stained with nicotinamide adenine dinucleotide (NADH) shows area of marked thermocoagulation surrounding 4-mm hepatic vein.

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