In Vivo Efficacy of Laparoscopic Assisted Percutaneous Renal Cryotherapy: Evidence Based Guidelines for the Practicing Urologist

Alberto Breda, John S. Lam, Stephen Riggs, John T. Leppert, Dorina Gui, Jonathan W. Said, Peter G. Schulam, Arie S. Belldegrun

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Purpose: The treatment of small renal tumors continues to evolve in parallel with advances in ablative technology. We compared the lesion geometry of 3, 17 gauge cryoneedles to determine the most effective distance and configuration of the cryoneedles in an in vivo porcine kidney model. Materials and Methods: Argon gas based renal cryoablation was performed in 6 pigs using a laparoscopically assisted percutaneous approach. Cryoablation using a single cryoneedle and a template of 3 cryoneedles with various ice ball shapes, including elliptical, bulb-shaped and standard 17 gauge cryoneedles (Galil Medical, Plymouth Meadow, Pennsylvania) was performed in 3 pigs. Three additional pigs underwent renal cryoablation using elliptical cryoneedles in 3 triangular template configurations with the cryoneedles spaced 1, 1.5 and 2 cm apart, respectively. The animals were sacrificed a minimum of 2 weeks following treatment. Results: Elliptical cryoneedles achieved the largest area of necrosis when used in single and template configurations. When used in a template configuration of 3 needles 1, 1.5 and 2 cm apart from each other the calculated volume of necrosis was 4.3 × 4.5 × 2.5, 4.9 × 4.1 × 2.5 and 4.0 × 4.5 × 2.5 cm, respectively. Conclusions: Using a single 17 gauge cryoneedle is inadequate for treating most small renal tumors. Cryoneedles with an elliptical ice ball are most effective for achieving consistent and reliable tissue destruction. The 1.5 cm template configuration generated the largest area of necrosis. Our data suggest that with the current technology renal cryoablation should be limited to lesions not greater than 4 cm.

Original languageEnglish (US)
Pages (from-to)333-337
Number of pages5
JournalJournal of Urology
Volume179
Issue number1
DOIs
StatePublished - Jan 1 2008
Externally publishedYes

Fingerprint

Cryotherapy
Cryosurgery
Guidelines
Kidney
Swine
Necrosis
Ice
Technology
Argon
Needles
Urologists
Neoplasms
Gases
Therapeutics

Keywords

  • cryosurgery
  • kidney
  • kidney neoplasms
  • laparoscopy
  • swine

ASJC Scopus subject areas

  • Urology

Cite this

In Vivo Efficacy of Laparoscopic Assisted Percutaneous Renal Cryotherapy : Evidence Based Guidelines for the Practicing Urologist. / Breda, Alberto; Lam, John S.; Riggs, Stephen; Leppert, John T.; Gui, Dorina; Said, Jonathan W.; Schulam, Peter G.; Belldegrun, Arie S.

In: Journal of Urology, Vol. 179, No. 1, 01.01.2008, p. 333-337.

Research output: Contribution to journalArticle

Breda, Alberto ; Lam, John S. ; Riggs, Stephen ; Leppert, John T. ; Gui, Dorina ; Said, Jonathan W. ; Schulam, Peter G. ; Belldegrun, Arie S. / In Vivo Efficacy of Laparoscopic Assisted Percutaneous Renal Cryotherapy : Evidence Based Guidelines for the Practicing Urologist. In: Journal of Urology. 2008 ; Vol. 179, No. 1. pp. 333-337.
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abstract = "Purpose: The treatment of small renal tumors continues to evolve in parallel with advances in ablative technology. We compared the lesion geometry of 3, 17 gauge cryoneedles to determine the most effective distance and configuration of the cryoneedles in an in vivo porcine kidney model. Materials and Methods: Argon gas based renal cryoablation was performed in 6 pigs using a laparoscopically assisted percutaneous approach. Cryoablation using a single cryoneedle and a template of 3 cryoneedles with various ice ball shapes, including elliptical, bulb-shaped and standard 17 gauge cryoneedles (Galil Medical, Plymouth Meadow, Pennsylvania) was performed in 3 pigs. Three additional pigs underwent renal cryoablation using elliptical cryoneedles in 3 triangular template configurations with the cryoneedles spaced 1, 1.5 and 2 cm apart, respectively. The animals were sacrificed a minimum of 2 weeks following treatment. Results: Elliptical cryoneedles achieved the largest area of necrosis when used in single and template configurations. When used in a template configuration of 3 needles 1, 1.5 and 2 cm apart from each other the calculated volume of necrosis was 4.3 × 4.5 × 2.5, 4.9 × 4.1 × 2.5 and 4.0 × 4.5 × 2.5 cm, respectively. Conclusions: Using a single 17 gauge cryoneedle is inadequate for treating most small renal tumors. Cryoneedles with an elliptical ice ball are most effective for achieving consistent and reliable tissue destruction. The 1.5 cm template configuration generated the largest area of necrosis. Our data suggest that with the current technology renal cryoablation should be limited to lesions not greater than 4 cm.",
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AB - Purpose: The treatment of small renal tumors continues to evolve in parallel with advances in ablative technology. We compared the lesion geometry of 3, 17 gauge cryoneedles to determine the most effective distance and configuration of the cryoneedles in an in vivo porcine kidney model. Materials and Methods: Argon gas based renal cryoablation was performed in 6 pigs using a laparoscopically assisted percutaneous approach. Cryoablation using a single cryoneedle and a template of 3 cryoneedles with various ice ball shapes, including elliptical, bulb-shaped and standard 17 gauge cryoneedles (Galil Medical, Plymouth Meadow, Pennsylvania) was performed in 3 pigs. Three additional pigs underwent renal cryoablation using elliptical cryoneedles in 3 triangular template configurations with the cryoneedles spaced 1, 1.5 and 2 cm apart, respectively. The animals were sacrificed a minimum of 2 weeks following treatment. Results: Elliptical cryoneedles achieved the largest area of necrosis when used in single and template configurations. When used in a template configuration of 3 needles 1, 1.5 and 2 cm apart from each other the calculated volume of necrosis was 4.3 × 4.5 × 2.5, 4.9 × 4.1 × 2.5 and 4.0 × 4.5 × 2.5 cm, respectively. Conclusions: Using a single 17 gauge cryoneedle is inadequate for treating most small renal tumors. Cryoneedles with an elliptical ice ball are most effective for achieving consistent and reliable tissue destruction. The 1.5 cm template configuration generated the largest area of necrosis. Our data suggest that with the current technology renal cryoablation should be limited to lesions not greater than 4 cm.

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