The patient in this procedure was Ms. H, 53 years old, diagnosed with stage IIIC ovarian intestinal-type adenocarcinoma. She had previously undergone robot-assisted cytoreductive surgery for ovarian malignant tumor at the First Affiliated Hospital of Jinan University — total hysterectomy, bilateral adnexectomy, pelvic and para-aortic lymph node dissection, and resection of the greater omentum, appendix, retroperitoneal mass, and abdominal wall tumor; part of the liver lesion was also resected during the same procedure. After such a major operation that “practically went through the entire abdominal cavity,” she received regular chemotherapy and completed seven cycles.

However, the latest contrast-enhanced MRI was not encouraging: multiple intrahepatic nodules were judged on imaging to be metastatic lesions — the lesions in segments S6 and S7 had enlarged compared with before, while the S2 lesion was similar to before. Chemotherapy had not stopped the progression in the liver.

At this point, Ms. H’s physical condition no longer allowed another major surgery: post-chemotherapy myelosuppression, abnormal liver function indicators, and comorbid hypertension. Her treatment path had reached a dilemma of “the tumor is progressing while the body is sending alarm signals.”

What was even more challenging was the location of the lesions: the S6 lesion was close to the liver capsule, while the S7 lesion was located in the angle between the right hepatic vein and the inferior vena cava, tightly adjacent to the diaphragm — the lesions were in awkward locations and were scattered from one another. Treating any one of them could not injure the “neighbors,” and complete coverage of all three still had to be ensured.

After comprehensive departmental evaluation, Ms. H did not meet the conditions for another major surgery, and chemotherapy had also reached a bottleneck. It was therefore decided to use local ablation to treat the progressing intrahepatic lesions.

The procedure was performed by Deputy Director Jiang Xiangwu of the Department of Interventional Vascular Surgery, using local anesthesia: subcutaneous injection of lidocaine for local infiltration, supplemented by intramuscular pethidine for analgesia — no “major anesthesia,” no intubation, and the patient remained awake throughout.

The core of the procedure lay in “one needle traveling throughout.” Under image guidance, Director Jiang punctured the Wknife integrated bipolar single needle into the first lesion, placed the needle, ablated, and withdrew the needle, then adjusted the angle and depth to enter the second and third lesions — the three lesions were distributed in different parts of the liver, with different needle insertion routes, and a single needle precisely reached each one in turn, completing ablation one after another.

It is worth mentioning the management of two “high-risk neighbors”: for the lesion close to the liver capsule, the needle tip was precisely positioned against the inner side of the capsule, with the ablation boundary fitting tightly; for the lesion tightly adjacent to the diaphragm, the ablation process was stable, the patient tolerated it well throughout, and there was no obvious pain response.

The entire ablation process took about 20 minutes, and together with preoperative preparation, the total procedure time was about one hour. The patient recovered smoothly after the procedure.