Gallbladder decompression and hydrodissection as adjuncts for ablation of pericholecystic hepatocellular carcinomas

Microwave ablation is an effective treatment for hepatocellular carcinoma, but tumors adjacent to extrahepatic organs carry a higher risk for thermal injury. Thermoprotective techniques such as hydrodissection and gallbladder decompression can reduce this risk and expand the range of lesions amenable to percutaneous treatment. We present a case of a 68-year-old woman with hepatocellular carcinoma in hepatic segment V, with partial treatment response from prior transarterial chemoembolization. Due to the lesion's proximity to the gallbladder and transverse colon, microwave ablation was performed with concurrent ultrasound- and CT-guided gallbladder decompression and hydrodissection. The ablation was technically successful without post-procedural complications. At 12-month follow-up, MRI demonstrated no residual tumor. This case highlights the feasibility of microwave ablation in anatomically challenging locations using thermoprotective strategies, overcoming technical challenges that may otherwise preclude minimally invasive treatment.