(1) Background: Percutaneous microwave ablation (MWA) is an accepted treatment of non-operative liver cancer. This study compares the ablation zones of four commercially available 2.45 GHz MWA systems (Emprint, Eco, Neuwave, and Solero) in an ex vivo porcine liver model. (2) Methods: Ex vivo porcine livers (n = 85) were obtained. Two ablation time setting protocols were evaluated, the manufacturer’s recommended maximum time and a 3 min time, performed at the manufacturer-recommended maximum power setting. A total of 236 ablation samples were created with 32 (13.6%) samples rejected. A total of 204 samples were included in the statistical analysis. (3) Results: For single-probe protocols, Emprint achieved ablation zones with the largest SAD. Significant differences were found in all comparisons for the 3 min time setting and for all comparisons at the 10 min time setting except versus Neuwave LK15 and Eco. Emprint produced ablation zones that were also significantly more spherical (highest SI) than the single-probe ablations from all other manufacturers. No statistical differences were found for ablation shape or SAD between the single-probe protocols for Emprint and the three-probe protocols for Neuwave. (4) Conclusions: The new Emprint HP system achieved large and spherical ablation zones relative to other 2.45 GHz MWA systems.

Pulmonary malignancies encompassing both primary lung cancer and metastatic lesions are a leading cause of cancer-related mortality globally. Percutaneous thermal ablation of primary and metastatic lung tumors using radiofrequency ablation, microwave ablation, or cryoablation has emerged as an established minimally invasive treatment modality for selected patients unsuitable for surgery or requiring lung preservation. Although most lung ablation complications are self-limiting, some adverse events may result in long-term morbidity or mortality. Post-ablation pneumothorax has the highest reported incidence, with pooled incidences of 37–44%, although rates may vary according to patient cohorts and study definitions. As indications for percutaneous thermal ablation of pulmonary lesions expand to include complex lesions or higher-risk patients, the prevention and management of procedure-related complications remain central to safe clinical practice. Although prior reviews have described the techniques, oncological outcomes, and complication profiles of image-guided lung ablation, less emphasis has been placed on integrating practical complication prevention and management strategies throughout the periprocedural workflow. This narrative review aims to synthesize various complication prevention and management strategies for percutaneous thermal ablation of both primary and metastatic pulmonary lesions. The review focuses on both common and rare complications, and various aspects of complication prevention such as patient/lesion selection, procedural planning, and anesthesia/respiratory control. A comprehensive understanding of complication profiles and mitigation strategies is essential to optimize procedural safety, guide patient selection, and establish ablative techniques as a pillar in multidisciplinary thoracic oncology care.