---
title: Two probe microwave ablation of a large liver metastasis
description: Tissue spearing microwave ablation after extended right hemihepatectomy. Two lesions were were treated with a double needle configuration.
image: https://www.cascination.com/hubfs/01_Case_Z%C3%BCrich_01_2022_Plan_3d.png
---

 Monday, 7 March 2022

# Two probe microwave ablation of a large liver metastasis

Two probe microwave ablation of a large liver metastasis

2:39

 

Tissue spearing microwave ablation after extended right hemihepatectomy. Lesion, progressive in size to 43 x 36 mm at the time of the intervention, was fully covered by the ablation volume. In addition a 5-mm satellite tumour dorsocranial to the main lesion showed in the planning scan. They were treated with a double needle configuration and repositioning after the initial ablation. In the postinterventional control scan, the lesion was completely covered without evidence of periinterventional complications.

![01_Plan2_2022-01-17Freiburg_case](https://www.cascination.com/hs-fs/hubfs/01_Plan2_2022-01-17Freiburg_case.png?width=1240&name=01_Plan2_2022-01-17Freiburg_case.png)

Planning scan showing the two trajectories with the expected large ablation zone of the dual needle configuration

![02_Needle2_3dFreiburg_case](https://www.cascination.com/hs-fs/hubfs/02_Needle2_3dFreiburg_case.png?width=1240&name=02_Needle2_3dFreiburg_case.png)

Needle verification scan of placed needles

 

![03_Assess_2022-01-21 142753_freiburg_case](https://www.cascination.com/hs-fs/hubfs/03_Assess_2022-01-21%20142753_freiburg_case.png?width=1240&name=03_Assess_2022-01-21%20142753_freiburg_case.png)

Showing the margin assessement of the ablation zone with Ablasure (with some artefacts due to needles still in place)

 

![04_Second_Plan_2022-01-17 142524_freiburg_case](https://www.cascination.com/hs-fs/hubfs/04_Second_Plan_2022-01-17%20142524_freiburg_case.png?width=1240&name=04_Second_Plan_2022-01-17%20142524_freiburg_case.png)

Planning of re-ablation to increase the size of the ablation zone and cover the satellite lesion as well

---

**Name: **Prof. Dr. Wibke Uller and Dr. Michael Doppler 

---

**Institution:** [Universitätsklinikum Freiburg](https://www.uniklinik-freiburg.de/en/uniklinikum.html), Freiburg (Germany)

---

**Patient age and sex: **64 years, male

---

**Initial condition:**

- 2016: Initial diagnosis of a neuroendocrine tumour of the pancreatic head. Condition after laparoscopic enucleation
- 2017: During follow-up, hepatic space-occupying lesions were noted, as well as a stenosing space-occupying lesion of the right colonic felxur. Histological confirmation of the space-occupying mass of the colon (adenocarcinoma of the colon)
- 2017: right hemicolectomy, and atypical liver resection from liver segments II/III, III, and extended right hemihepatectomy (multi-stage procedure). Detection of hepatic metastases of adenocarcinoma of the colon in the intraoperative fast track samples
- Since 2017: inconspicuous follow-up
- November 2021: Newly appeared mass in the central residual liver (39 x 32 mm)
- December 2021: Tumour board decision for microwave ablation

---

**Treatment:** 

- January 2022: Bioptic confirmation and MWA of the focus (pathology: metastasis of adenocarcinoma of the colon). In CT accompanying the examination, the lesion was progressive in size to currently 43 x 36 mm
- In addition, a new 5-mm satellite dorsocranial to the main lesion was seen compared with the previous findings

---

**Conclusion:** 

- In the postinterventional control, the lesion was completely covered without evidence of periinterventional complications
- Follow-up by MRI or CT is still pending

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

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