UpdateRenal cryosurgery
Section snippets
Histologic features
The histologic sequelae of renal cryoablation show characteristic features of irreversible cell death. At 1 hour, gross examination of the acute renal cryolesion demonstrates a well-defined area of dark red, interstitial hemorrhage with an abrupt line of demarcation. On light microscopy, generalized vascular congestion is evident with only subtle signs of early coagulation necrosis. Electron microscopy shows marked ultrastructural evidence of irreversible cell death4: partial fragmentation and
Radiologic aspects
The availability of sophisticated and reliable ultrasound, allowing real-time monitoring of the evolving cryolesion, is one of the main reasons for the current resurgence of interest in visceral cryosurgery. Onik and colleagues6 initially reported that the evolving renal ice ball possesses a hyperechoic, crescentic advancing edge with posterior acoustic shadowing.
During clinical laparoscopic renal cryoablation, intraoperative laparoscopic ultrasound (IOLUS) is a reliable and vital imaging
Experimental studies
The multiple studies currently available attest to the predictable tissue necrosis caused by renal cryoablation. A renal cryolesion contracts in size over time.9 In the early postoperative period, a large central area of coagulative necrosis is surrounded by a narrow zone of sublethal injury. By 3 months, the area of necrosis is completely absorbed and replaced by fibrosis. Even momentary contact of the iceball or the active cryoprobe with adjacent structures such as the ureter, peritoneum, or
Open surgical procedure
Delworth and colleagues13 performed open cryoablation in 2 patients with a solitary kidney. One patient had a 3-cm renal cell tumor and the other had a 10-cm angiomyolipoma. The operative time was 3.5 and 4.5 hours, with a blood loss of 200 and 700 mL, respectively. The hospital stay was 5 days, and the postoperative serum creatinine was 1.3 mg/dL in both patients. Follow-up MRI revealed a “significant decrease…consistent with resorption” in the renal cell carcinoma at 1 month and a 10%
Conclusions
Clinical renal cryosurgery is currently in its infancy. The kidney may be an anatomically favored organ for cryosurgery. Unlike the prostate, which is in intimate, fixed contact with the rectum and the sphincteric mechanism, the kidney can be surgically mobilized, thereby minimizing chances of injury to vital adjacent structures. Furthermore, although the prostate often harbors multifocal carcinoma, the kidney usually presents with unifocal malignancy. Since the renal tumor can actually be
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