Laparoscopic renal cryoablation in 32 patients

• Published in: Urology (Ridgewood, N.J.) Vol. 56; no. 5; pp. 748 - 753
• Main Authors: Gill, Inderbir S, Novick, Andrew C, Meraney, Anoop M, Chen, Roland N, Hobart, Michael G, Sung, Gyung Tak, Hale, Jonathan, Schweizer, Dana K, Remer, Erick M
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2000; Elsevier Science
• Subjects: Adenoma, Oxyphilic - diagnosis; Adenoma, Oxyphilic - surgery; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Biopsy; Carcinoma, Renal Cell - diagnosis; Carcinoma, Renal Cell - diagnostic imaging; Carcinoma, Renal Cell - surgery; Cryosurgery - methods; Follow-Up Studies; Humans; Intraoperative Period; Kidney Neoplasms - diagnosis; Kidney Neoplasms - diagnostic imaging; Kidney Neoplasms - surgery; Kidneys; Laparoscopy - methods; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Tomography, X-Ray Computed; Treatment Outcome; Tumors of the urinary system; Ultrasonography; Kidney disease; Human; Endoscopic surgery; Urinary system disease; Small dimension; Radiodiagnosis; Laparoscopy; Ablation; Kidney; Pathology; Treatment; Biopsy; Surgery; Medical imagery; Tumor; Computerized axial tomography; Cryotherapy
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/S0090-4295(00)00752-4

Objectives. Laparoscopic renal cryoablation is a developmental minimally invasive nephron-sparing treatment alternative for highly select patients with small renal tumors. We present our evolving experience with this procedure. Methods. Thirty-two patients (34 tumors) with a mean tumor size of 2.3 cm on preoperative computed tomography underwent laparoscopic renal cryoablation. As dictated by the tumor location, cryoablation was performed by either the retroperitoneal (n = 22) or the transperitoneal (n = 10) laparoscopic approach using real-time ultrasound monitoring. A double freeze-thaw cycle was routinely performed. Results. The mean surgical time was 2.9 hours, cryoablation time 15.1 minutes, and blood loss 66.8 mL. For a mean intraoperative ultrasonographic tumor size of 2 cm, the mean cryolesion size was 3.2 cm. The hospital stay was less than 23 hours in 22 (69%) of 32 patients. Sequential magnetic resonance imaging scans demonstrated a gradual contraction in the mean diameter of the cryolesions. Of the 20 patients who underwent a 1-year follow-up magnetic resonance imaging scan, the cryoablated tumor was no longer visible in 5. Of note, 23 patients have now undergone a 3 to 6-month follow-up computed tomography-directed biopsy of the cryoablated tumor site; the biopsy was negative for cancer in all 23 patients. No evidence of local or port-site recurrence was found during a mean follow-up of 16.2 months. Conclusions. Critical long-term data regarding laparoscopic renal cryoablation, a developmental technique, are awaited. However, our initial experience is cautiously optimistic. Despite its significant potential for false-negative results, it is encouraging that the follow-up computed tomography-directed needle biopsies at 3 to 6 months were negative for cancer in 23 of 23 patients.