---
title: RCC pull-back microwave ablation with two trajectories and four ablation zones
description: MWA of HCC metastasis. Trajectory was planned between kidney and liver, going through fat tissue to reach the lesion adjacent to the right adrenal gland
---

 Tuesday, 16 August 2022

# RCC pull-back microwave ablation with two trajectories and four ablation zones

RCC pull-back microwave ablation with two trajectories and four ablation zones

2:32

 

Complex microwave ablation in a renal cell carcinoma patient previously treated with a surgery.  Patient treated with left nephrectomy for renal cell carcinoma in 2004. In 2021 a biopsy confirmed a progressively growing local recurrence. Patient was referred to the interventional radiology department. First, an radiofrequency to reduce the size of the lesion was performed, followed four months later by a pull-back microwave ablation with two trajectories and four ablation zones to cover the entire tumour volume. An immediate re-ablation to ensure all residual mass has been destroyed completed the treatment.

![01_Case_Zürich_01_2022_Plan_3d](https://www.cascination.com/hs-fs/hubfs/01_Case_Z%C3%BCrich_01_2022_Plan_3d.png?width=982&name=01_Case_Z%C3%BCrich_01_2022_Plan_3d.png)

Planning scan showing the two trajectories and four overlapping ablation zones

![02_Case_Zürich_01_2022_Needle_Validation](https://www.cascination.com/hs-fs/hubfs/02_Case_Z%C3%BCrich_01_2022_Needle_Validation.png?width=982&name=02_Case_Z%C3%BCrich_01_2022_Needle_Validation.png)

First needle verification scan

![03_Case_Zürich_01_2022_Pre-Post-Ablation](https://www.cascination.com/hs-fs/hubfs/03_Case_Z%C3%BCrich_01_2022_Pre-Post-Ablation.png?width=982&name=03_Case_Z%C3%BCrich_01_2022_Pre-Post-Ablation.png)

Side by side comparison of pre ablation image on the left and post-ablation image on the right

![05_Case_Zürich_01_2022_Post-Ablation](https://www.cascination.com/hs-fs/hubfs/05_Case_Z%C3%BCrich_01_2022_Post-Ablation.png?width=982&name=05_Case_Z%C3%BCrich_01_2022_Post-Ablation.png)  
Planning of re-ablation

---

**Name: **Dr. Levent Kara 

---

**Institution:** [Stadtspital Zürich Triemli](https://www.stadt-zuerich.ch/triemli/en/index.html), Zürich (Switzerland)

---

**Patient age and sex: **77 years, male

---

**Initial condition:**

- Patient was first diagnosed with a clear cell renal cell carcinoma pT1a cN0 cM0 on the left side in 2004
- Open surgery with complete left nephrectomy shortly afterwards
- Biopsy confirmed a progressively growing local recurrence in 2021
- In September 2021 the patient was referred to interventional radiology and treated with CAS-One IR guided RFA with the goal of the treatment to reduce the size of the lesion
- In January 2022 the entire lesion was treated with CAS-One IR guided MWA with a total of 5 (overlapping) ablation zones

---

**Treatment:** 

- Patient in prone position, intercostal, oblique access was chosen
- 2 trajectories, with a pulled back ablation for a total of 4 ablation zones was planned
- After the post-ablation scan, an additional ablation zone was planned to be absolutely sure to have no residual mass

---

**Conclusion:**

- CAS-One IR allowed planning of overlapping ablation zones to achieve an ablation volume big enough to cover the entire tumour volume with its atypical shape
- A suspicious looking potential underablated area was re-ablated immediately in the same session and full coverage of the tumour volume was achieved
- 3 month follow-up CT-scan showed slight decrease in volume of the lesion that is now in a liquid state 
- Patient remains under frequent surveillance 
- For this case microwave ablation showed to be significant more effective than RFA

Learn more about the stereotactic navigation system [CAS-One IR](https://www.cascination.com/products/cas_one_ir?hsLang=en).

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