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Introduction: Microwave is an emerging ablation technology in the treatment of HCC. We have used MWA for treatment of HCC with curative intent or as a bridge to transplantation since 2003 clinically. Currently, there are two MWA systems commercially available in the US. We here report our recent experience and short-term follow up.Method: A retrospective analysis in our MWA database was performed. All patients undergoing microwave ablation for HCC were included. Ablations were performed with a 915 MHz or a 2.45 GHz WA system. Results: 32 patients (28 M, 4 F, mean age 59.6 (range 46-83) underwent MWA for HCC from 3/2007 until 9/2009. The 2.45 GHz system was used in 19 patients, the 915 MHz system in 12 patients. Both systems were used in 1 patient. 28 (88%) cases were performed laparoscopically and 4 open. Average tumor size was 3.24cm (range 0.7-8cm). Using the 2.45 GHz system, 26 tumors were ablated with 51 applications, mean tumor size 3.3 cm, averaging 1.9 applications/tumor. The 915 MHz system was applied 32 times to 14 tumors, mean tumor size 3.1 cm, averaging 2.3 applications/tumor. One patient, undergoing a combination of liver resection and ablation died from a transection bed bleed. There was no other significant morbidity or mortality. Follow-up was obtained through 10/2009. Mean follow-up was 7.5 months (range 1-20 months). One patient was lost to follow-up. One local recurrence was noted at 15 months, and was re-ablated percutaneously. There were 4 regional recurrences at an average of 9.7 months. 2 patients were transplanted, 2 and 3 months respectively after ablation. The explants did not contain any viable tumor. Six patients died at an average of 5.5 months, without evidence of HCC. Conclusion: Microwave ablation is a safe and effective modality in the treatment of HCC, with limited morbidity in a high-risk patient population. Most patients can be treated with minimally invasive techniques.