Laparoscopic radiofrequency thermal ablation of renal tissue with and without hilar occlusion

Few studies have evaluated the effect of radiofrequency thermal ablation on renal tissue, although it has been used clinically to treat small renal masses. We studied the size and histology of lesions created with radiofrequency thermal ablation administered via the laparoscopic approach with and without hilar occlusion in a porcine model.

The lower pole of each kidney was exposed laparoscopically in 11 farm pigs. In each kidney a 7-electrode dry radiofrequency thermal ablation probe was inserted at an identical location and deployed to a diameter of 2 cm. Energy was applied for 8 minutes at an average temperature of 100C. The left renal hilum of each pig was clamped during radiofrequency thermal ablation. Two pigs were sacrificed immediately, and 3 each were sacrificed at 24 hours, 2 and 4 weeks. The size and shape of the lesions created were measured and examined histologically.

There were no intraoperative or postoperative complications. Laparoscopic ultrasound confirmed probe placement but did not monitor lesion progression. Acutely lesions were firm and white with a small adjacent hemorrhagic zone. Histological evaluation revealed preserved renal architecture but the loss of distinct cytoplasmic features. Nicotinamide adenine dinucleotide staining demonstrated no viable cells within the lesions. In surviving animals pelvicaliceal integrity was preserved. In the 2 and 4-week survival groups kidneys treated with hilar occlusion had larger lesions than nonoccluded kidneys but the differences were not significant at 4 weeks (3.2 x 2.7 x 2.5 cm. and 3.5 x 1.7 x 2.0, respectively, p >0.05). Histologically untreated parenchyma of hilar occluded kidneys demonstrated changes consistent with chronic pyelonephritis. In 1 kidney radiofrequency thermal ablation with hilar occlusion resulted in complete lower pole loss at 4 weeks.

In the porcine model renal radiofrequency thermal ablation creates rapid and completely devitalized lesions of consistent size and shape. Hilar occlusion may result in slightly larger lesions but risks damage to the whole renal unit.