One-lung ventilation to treat hepatic dome lesion – a further step towards minimally invasive surgery: a case report

• Main Authors: Francesco D’Amico, Simone Serafini, Michele Finotti, Marianna Di Bello, Chiara Di Renzo, Umberto Cillo
• Format: Article
• Language: English
• Published: BMC 2019-03-01
• Series: Journal of Medical Case Reports
• Subjects: Minimally invasive surgery; Hepatocellular carcinoma treatment; MW ablation; One-lung ventilation; Bridge to liver transplantation
• Online Access: http://link.springer.com/article/10.1186/s13256-019-1999-6

Abstract 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.