Transcatheter cooling of intrahepatic bile duct during microwave coagulation therapy: A procedure to prevent bile duct injury

Microwave coagulation therapy (MCT) is a widely used and effective minimal invasive therapy for liver tumor. Bile duct injury, however, is a major obstacle to complete tumor necrosis. To facilitate the use of MCT for a liver tumor adjacent to the major bile duct, we developed a method for transcatheter cooling of the major intrahepatic bile duct. The procedure for this technique is: (1) an angular catheter is inserted into the designated bile duct via the cystic duct after cholecystectomy, and a small longitudinal cut is made in the common bile duct for drainage of the cooling liquid; (2) cool saline is continuously infused into the bile duct via the inserted catheter during MCT; (3) after the MCT, the small opening in the common bile duct is simply closed with two or three sutures, and a C-tube is inserted to prevent stenosis of the common hepatic duct. MCT with this newly developed surgical technique enabled complete tumor necrosis and bile duct preservation, and the technique is strongly recommended for treatment of liver tumor adjacent to the major bile duct.