A 52-year-old male had hepatocellular carcinoma (HCC), located just above the main trunk of the right hepatic vein. Firstly, this patient was treated by TAE. However, the effect was incomplete, so the patient was referred to Kurashiki Medical Center for additional therapy. Microwave coagulation therapy (MCT) under laparotomy was performed due to the deterioration of hepatic functional reserve. The level of AFP decreased to the normal range. Recurrent HCC was found at medial segment of the liver by MRI taken seven months after the first MCT. MCT was performed again intraoperatively. The main trunk of the right hepatic vein was proved to be patent by enhanced CT. Furthermore, this patient has lived without tumor recurrence for 34 months after the second MCT. This case shows that MCT is a useful method to treat HCC located near the main hepatic vein.