To explore fundamental principles and techniques of the most common thermoprotection techniques used in ultrasound (US) guided percutaneous liver microwave ablation (MWA) for hepatocellular carcinoma (HCC).

Hepatocellular carcinoma (HCC) is the most prevalent form of primary liver cancer and is the third most common cause of cancer-related death worldwide [1]. In Australia, the incidence of HCC has been increasing more rapidly than that of other cancers [1,2]. HCC often arises in the context of chronic liver disease, with the dominant aetiologies being cirrhosis, chronic hepatitis B infection, alcohol misuse, and metabolic dysfunction-associated steatohepatitis (MASH) [1].Major clinical guidelines, particularly the Barcelona Clinic Liver Cancer (BCLC) staging system, recommend local treatment with thermal...

Artificial Ascites (hydro dissection)Purpose: Creation of a fluid layer around the liver near the treated area to protects adjacent organs from thermal injury. For hepatic dome tumours, artificial ascites also reduces post-procedure pain caused by diaphragmatic irritation and may create an acoustic window enablingaccess with US guidance [6,7].Procedure: US-guided puncture at the peritoneal interface using liver, gallbladder, or stomach walls as reference [8] (Fig. 1 and 2,); deployment of a catheter via direct method or Seldinger technique. At our institution, the 6.3Fr Dawson-Mueller catheter is...

The integration of ultrasound-guided thermoprotection techniques, whether used alone or in combination, proves to be an effective strategy for safeguarding vital structures and significantly enhancing procedural safety. When meticulously applied in clinical practice, these methods directly improve patient outcomes and reduce procedural risks.

Gunasekaran, U., Smith, R. C., Fraser, J. D., & Wallace, M. C. (2023). Rising incidence of hepatocellular carcinoma in Australia: Is it time to screen for metabolic associated fatty liver disease? Medical Journal of Australia, 218(6), 271-273. https://doi.org/10.5694/mja2.52124 Australia, C. (2020). Liver cancer in Australia statistics [Internet]. Cancer Australia. Available from: https://www.canceraustralia.gov.au/cancer-types/liver-cancer/statistics Reig, M., Forner, A., Rimola, J., Ferrer-Fàbrega, J., Burrel, M., Garcia-Criado, Á., Kelley, R. K., Galle, P. R., Mazzaferro, V., Salem, R., Sangro, B., Singal, A. G., Vogel, A., Fuster, J., Ayuso, C.,...