Videolaparoscopic MicroWave Ablation: An innovative technique to treat pancreatoblastoma liver metastases in children

Background: The MicroWave Ablation (MWA) is a mini-invasive technique, based on dielectric heating, used to treat small hepatic tumors or liver metastases in the adult population. The heat-energy is delivered to the target area, causing tumor necrosis, usually under ultrasound or computed tomography guidance. This procedure can be performed as pure percutaneous or with laparoscopic assistance. Operative technique: A laparoscopic US-guided microwave ablation of the pancreatoblastoma hepatic metastasis was performed in an 11-year old girl. A standard three-port laparoscopic technique was used: the camera port at the umbilicus, and two working port at the upper right quadrant. After adhesiolysis, the intra-operative liver ultrasonography confirmed the pre-operative morphological imaging study and the nodules ablation was performed by using microwaves (MWA), emitted by AMICA probe (Apparatus for MICrowave Ablation; HS Hospital Service, Aprilia, LT, Italy), set at 40 W. Conclusions: Laparoscopic MWA is a tissue-sparing technique to treat in a mini-in vasive fashion unresectable liver tumors or metastases. This technique has been extensively described in adult population, and rarely in children. These preliminary and satisfactory results make MWA promising when treating pediatric patients with malignant primary or secondary liver tumors. Further studies may provide data on its long-term efficacy and safety.