الفهرس 
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Abstract
Hepatocellular carcinoma (HCC) is one of the most common types of malignancy in humans and is also one of the most difficult types of cancer to treat. Surgical resection can change the natural course of HCC at early stages.
Unfortunately, because of tumor multifocality, portal venous thrombosis, and underlying advanced liver cirrhosis, surgical resection can be performed in only 20% of patients. Therefore, non surgical treatment is the only available option for the majority o patients with HCC.
Several minimally invasive techniques have been used for the local ablation of liver lesions including laser, microwave, radiofrequency, cryotherapy and ethanol ablation. the main limitation of these techniques is the difficulty in ablating HCC more than 5 cm in diameter.
HIFU is an extracorporeal technology for the thermal ablation of tumors. An ultrasound beam can be focused using an extracorporeal transducer to thermally ablate a large tumor without requiring surgical exposure or insertion of instruments into the lesion.
HIFU provides a less painful treatment option for patients, no appreciable load on the hepatic reserve as compared to chemoembolization and no chance for skin wound infection.
However, despite all these advantages HIFU is not and must not be considered as magic .It is still a technique that has its own limitations
Challenges such as patient position during anesthesia, tumor position, time and ventilation control during anesthesia are the major limitation of such technique narrowing the extent of its use.
That is why it is so important to have good experience and enough orientation about the other available techniques allowing the best treatment decision to be made.