Laparoscopic renal cryoablation in 32 patients

Objectives. Laparoscopic renal cryoablation is a developmental minimally in vasive nephron-sparing treatment alternative for highly select patients wit h small renal tumors. We present our evolving experience with this procedur e. Methods. Thirty-two patients (34 tumors) with a mean tumor size of 2.3 cm o n preoperative computed tomography underwent laparoscopic renal cryoablatio n. As dictated by the tumor location, cryoablation was performed by either the retroperitoneal (n = 22) or the transperitoneal (n = 10) laparoscopic a pproach using real-time ultrasound monitoring. A double freeze-thaw cycle w as routinely performed. Results. The mean surgical time was 2.9 hours, cryoablation time 15.1 minut es, and blood loss 66.8 mt. For a mean intraoperative ultrasonographic tumo r 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 resonanc e imaging scans demonstrated a gradual contraction in the mean diameter of the cryolesions. Of the 20 patients who underwent a 1-year follow-up magnet ic 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 n egative for cancer in all 23 patients. No evidence of local or port-site re currence was found during a mean follow-up of 16.2 months. Conclusions. Critical long-term data regarding laparoscopic renal cryoablat ion, a developmental technique, are awaited. However, our initial experienc e is cautiously optimistic. Despite its significant potential for false-neg ative results, it is encouraging that the follow-up computed tomography-dir ected needle biopsies at 3 to 6 months were negative for cancer in 23 of 23 patients. UROLOGY 56: 748-753, 2000, (C) 2000, Elsevier Science Inc.