Background: Although liver resection is still the best treatment for primary or metastatic hepatic lesions, a conventional surgical approach may be challenging in patients with a history of previous abdominal surgery. We present a case of a 58-year-old white man with paracaval, subdiaphragmatic, recurrent hepatocellular carcinoma; he had a history of multiple abdominal surgeries.
Methods: In select patients, percutaneous ultrasound-guided thermal ablation is a valid non-surgical alternative due to its safety, efficacy, and good tolerability. Hepatic lesions located in the posterosuperior segments, however, can be difficult to reach via a percutaneous approach.
Result: For these cases, one-lung left-sided ventilation may be particularly helpful in blocking the right hemidiaphragm and improving the acoustic window to the liver.
Conclusion: We present a case of paracaval, subdiaphragmatic, recurrent hepatocellular carcinoma in which the tumor was only reachable after one-lung left-sided ventilation that was successfully treated by percutaneous ultrasound-guided microwave ablation.
Keywords: Bridge to liver transplantation; Hepatocellular carcinoma treatment; MW ablation; Minimally invasive surgery; One-lung ventilation.