Ep. 577 Microwave Ablation for Liver Tumors: Techniques & Outcomes with Dr. Driss Raissi

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Sep 30, 2025

Dr. Driss Raissi, an interventional radiologist and division chief at the University of Kentucky, shares his expertise in microwave ablation techniques. He discusses using innovative strategies to tackle various complex cases, including large liver tumors and challenging fistulas. Dr. Raissi introduces his pre-burn technique to reduce complications and reveals his 'lung seal technique' for lung ablation. He also compares microwave versus cryoablation for different tumor types, emphasizing collaboration and effective communication in optimizing ablation outcomes.

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INSIGHT

Microwave As A Versatile Tool

Microwave is a versatile 'Swiss Army knife' for interventional radiology when mastered over many cases.
Mastery expands indications beyond simple chip shots into complex, high-risk lesions.

ADVICE

Start With A Pre-Burn And Track Ablation

Do a 'pre-burn' (45–75 W for ~1 minute) at the start of ablations to desiccate tissue and fixate the needle.
Also always perform track ablation after any needle movement to reduce seeding and bleeding risks.

ADVICE

Overlap Spheres For Large Liver Lesions

For larger liver tumors, place centrally then create overlapping spherical ablations with 1–2 cm overlap.
Pull back and reposition the single probe in 3D to overlap full coverage instead of multiple initial needle sticks.

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Is microwave ablation only for simple liver tumors, or can it be a versatile ‘Swiss Army knife’ for a wide range of complex cases? In this episode, Dr. Driss Raissi of the University of Kentucky returns to BackTable to join host Dr. Chris Beck for a deep dive into advanced and unconventional microwave ablation techniques. They cover strategies for tackling a wide range of cases, from desmoid tumors to enterocutaneous fistulas.
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This podcast is supported by:
Medtronic Emprint
https://www.medtronic.com/emprint
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SYNPOSIS
Dr. Raissi shares his ‘pre-burn’ technique that desiccates tissue and reduces complications like capsular burst and bleeding. He elaborates on his method for tackling large liver tumors with a single probe through overlapping ablations, needle placement techniques and his ‘lung seal technique’ to prevent pneumothorax. Dr. Raissi also shares how his previous experience in the ICU promotes close communication with anesthesiologists and how he ups his ablation game through collaboration, optimizing conditions for safe and effective ablation.
The episode explores a series of unique, real-world applications beyond the usual scope of IRs. Dr. Raissi walks us through his novel approach to challenging cases, including cauterization of enterocutaneous fistulas, endometriomas and desmoid tumors. He also compares using microwave or cryoablation for renal cell carcinoma, explaining thought processes based on lesion location and the need for speed and simplicity. The discussion provides an overview of ablation physics and careful techniques that expand treatment possibilities for IR patients.
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TIMESTAMPS
00:00 - Introduction
04:08 - Advanced Techniques for Liver Tumor Ablation
06:06 - Pre-Burning Ablation and Ablating a Range of Lesions
16:38 - Lung Ablation
22:00 - Partnering with Anesthesia
28:53 - Managing Postoperative Pain and Nerve Injuries
29:42 - Treating Enterocutaneous Fistulas, Endometriomas & Desmoid Tumors
38:49 - Adrenal Gland Ablation: A Case Study
44:50 - Microwave vs. Cryoablation for Renal Cell Carcinoma
49:06 - Preventing Pneumothorax in Lung Ablation