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Initial experience with laparoscopically assisted percutaneous cryotherapy of renal tumors
John L Gore1, Hyung L Kim, Peter Schulam
1Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, California 90095, USA.
Background And Purpose:
Laparoscopic renal cryoablation is a feasible therapeutic option for small renal tumors. Advances in cryoablation technology have produced smaller cryoprobes. We review our initial experience with laparoscopic cryoablation utilizing 17-gauge cryoneedles.
Patients And Methods:
Four patients aged 21 to 78 years underwent laparoscopy-assisted percutaneous cryotherapy between May 2003 and March 2004. The tumor size ranged from 1.5 to 2.5 cm. The procedure involved transperitoneal exposure of the tumor utilizing three 5- or 10-mm ports. The cryoprobes were placed percutaneously, without the need for tract dilation. Two freeze-thaw cycles were performed with cooling to below -70 degrees C.
Results:
In all patients, the procedure was completed without complication. The mean operative time was 125 minutes. The mean blood loss was 29 mL. No perioperative complications occurred. In follow-up, one patient with a tumor suspected of being renal-cell carcinoma demonstrated residual enhancement and underwent percutaneous radiofrequency ablation.
Conclusions:
Laparoscopy-assisted percutaneous cryotherapy is a feasible treatment option in patients with small renal tumors. Laparoscopy allows mobilization of both anterior and posterior tumors. Direct viewing of the mass may facilitate accurate placement of the cryoneedles. The small size of the cryoneedles minimizes bleeding at the entry site.
