Korean J Urol.  2007 Apr;48(4):363-370. 10.4111/kju.2007.48.4.363.

The Initial Experience with 3rd Generation Nephron-sparing Cryoablation for Renal Tumor

• Park MG
• Kang SH
• Cheon J

• KMID: 1997101
• DOI: http://doi.org/10.4111/kju.2007.48.4.363

Abstract

PURPOSE
We report here on our initial experience with 3rd generation nephron-sparing renal cryoablation, which is one of the minimal invasive nephron-sparing surgeries.
MATERIALS AND METHODS
We enrolled 10 patients who had renal neoplasm identified on computed tomography (CT) and who underwent 3rd generation cryoablation from August 2004 to May 2006. The operative indications were a tumor less than 4cm in diameter, an exophytic mass with malignant potential and those cases like solitary kidney, bilateral tumor or renal insufficiency that needed preservation of renal function. Eight patients underwent minimal incision open cryoablation, and the other two underwent laparoscopic cryoablation. In every case, there were 2-3 cycles of freeze and thawing and we monitored the tumor and ice ball via intraoperative ultrasound.
RESULTS
The size of the iceball was maintained more than 1cm apart from the margin of the tumor to secure a safety margin. The average operation time of open cryoablation was 1.7 hr and that of laparoscopic cryoablation was 2.2 hr; the average blood loss was 194cc and 55cc, respectively. The average period of hospitalization after operation was 6.6 days and 3 days, respectively, and there was no complication except for one patient who had postoperative pulmonary effusion. During a mean follow-up of 14.1 months, no patient died and all the patients except one remained without local recurrence.
CONCLUSIONS
As a result of our initial experience, renal cryoablation turned out to have an excellent effect of tumor erradication and few complications. Although long term follow-up results are necessary, laparoscopic renal cryoablation is considered a minimal invasive nephron- sparing surgery that could be substituted for laparoscopic partial nephrectomy in the future.

Keyword

Renal neoplasm; Cryoablation

MeSH Terms

Cryosurgery*
Follow-Up Studies
Hospitalization
Humans
Ice
Kidney
Kidney Neoplasms
Nephrectomy
Recurrence
Renal Insufficiency
Ultrasonography
Ice

Figure

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  Fig. 1 Freezing and thawing. Laparoscopic view of the renal tumor during a freezing and thawing cycle of laparoscopic cryoablation with using 3 cryoprobes. (A) During the freeze cycle, ice ball formation is visualized on the laparoscopic view and by real-time ultrasonogram. (B) During the thawing cycle, the circumferential purplish ring signifies the area encompassed by the ice ball.

• 

  Fig. 2 Computed tomography (CT) imaging before and 12 month after cryotherapy. CT imaging before and 12 month after cryotherapy. Sequential change of the cryolesion as seen on CT. (A) Before cryotherapy, the left renal tumor (size: 3.2cm, well enhanced) is indicated by the arrow. (B) The cryolesion 12 months after cryotherapy (size: 1.6cm, not enhanced) indicated by the arrow. Follow-up CT scanning 12 months after cryotherapy showed contraction and shrinkage of the cryoablated tumor and the nonenhancing defect in the cryoablated area.

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