LAPAROSCOPIC RENAL CRYOABLATION - INITIAL CLINICAL-SERIES

Objectives. To present the technique and short-term results of retrope ritoneal laparoscopic renal cryoablation. Methods. Ten patients underw ent laparoscopic renal cryoablation of 11 exophytic renal tumors rangi ng in size from 1.5 to 3 cm identified on computed tomography. Tumors were located at the upper (3), middle (5), or lower (3) pole of the ki dney. Three patients had a solitary kidney. A 3-port retroperitoneal l aparoscopic approach was used to create renal cryolesions. Puncture cr yoablation was performed with a 4.8-mm cryoprobe. Real-time, endoscopi c, steerable, color Doppler ultrasound was used to monitor the evolvin g cryolesion. All patients have completed a;minimum follow-up of 3 mon ths (mean 5.5, range 5 to 9). Results. Cryoablation was technically su ccessful in all 10 patients (11 tumors). Under ultrasound guidance, th e ice ball was intentionally created up to 1 cm beyond the tumor edge with the aim of achieving negative margins. Mean surgical time was 2.4 hours, cryoablation (double freeze-thaw) time 12.9 minutes, cryoprobe tip temperature -186 degrees C, and blood loss 75 mL. Systemic temper ature remained unaltered. Hospital stay was less than 23 hours in 9 of 10 patients. Follow-up magnetic resonance imaging at 1 day and 1, 2, and 3 months identified the punched-out, nonenhancing, spontaneously r esorbing, renal cryolesion. Follow-up biopsies of the cryoablated tumo r site were negative for cancer in the 3 patients who have undergone t he biopsy. Conclusions. The initial series of laparoscopic renal cryoa blation is presented. The retroperitoneoscopic approach, by avoiding t he peritoneal cavity, minimizes the chances of the bowel coming in con tact with the evolving cryolesion, and the potential sequelae thereof. Laparoscopic renal cryoablation is currently developmental and long-t erm data are awaited. Nevertheless, it is potentially an attractive ad dition to available nephron-sparing surgical techniques. UROLOGY 52: 5 43-551, 1998. (C) 1998, Elsevier Science Inc. All rights reserved.