Initial Experience with Urologist Directed Ultrasound Guided Percutaneous Renal Cryoablation

John Danella, Matthew Cindric*, Brant Fulmer, Jennifer Simmons*, Daniel Rukstalis
Geisinger Medical Center, Danville, PA

Introduction: We present our initial experience with percutaneous renal cryoablation performed exclusively by urologists using real time ultrasound guidance>
Methods: 14 patients with suspicious renal masses were selected for percutaneous renal cryoablation after transabdomnal imaging demonstrated the mass and a safe route for percutaneous cryoprobe insertion. Patients were treated in a standard operating room under general anesthesia. Real time ultrasound guidance directed placement of one to three cryoprobes. A double freeze-thaw technique was employed exclusively.
Results: Follow-up ranges from 1 to 10 months (median 3 months). Mass size ranged from 2.2 to 4.6 cm. Operative time ranged from 38 to 60 minutes and all patients were discharged <24 hours after surgery. All masses appeared to be successfully ablated as determined sonographically. Biopsies demonstrated renal cell carcinoma in 6, oncocytoma in 1, nephroblastoma in 1, and were indeterminate in 6. Four patients had minor adverse events and one patient required a ureteral stent placement. Follow up imaging has been done in 4 patients thus far: 3 demonstrate an infarcted lesion and 1 has a stable mass that enhances partially. Pathologic follow up in one patient demonstrated infarction of the targeted lesion.
Conclusions: Urologist directed ultrasound guided percutaneous renal cryoablation is a safe, minimally invasive method of treating small renal malignancies. As these procedures are performed in the operating room, conversion to a laparoscopic approach is possible if percutaneous access is suboptimal. Further follow-up is necessary to judge the fficacy of this approach.

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