Comparison of Percutaneous and Laparoscopic Cryoablation for the Treatment of Solid Renal Masses
J. Louis Hinshaw1,
Anthony M. Shadid1,
Stephen Y. Nakada2,
Sean P. Hedican2,
Thomas C. Winter, III1 and
Fred T. Lee, Jr.1
1 Department of Radiology, University of Wisconsin, 600 Highland Ave., E3/311
CSC, Madison, WI 53792-3252.
2 Department of Surgery, Division of Urology, University of Wisconsin, Madison,
WI.
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Fig. 1A —Laparoscopic cryoablation of renal tumors. Intraoperative
photograph shows exophytic renal cell carcinoma (RCC) (arrows), which
has been mobilized and exposed in preparation for cryoablation.
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Fig. 2B —Percutaneous renal cryoablation of renal tumor in 77-year-old
woman. Unenhanced CT image obtained during cryoablation shows low-attenuation
ice ball (arrow) that has formed around cryoprobes, completely
enveloping tumor.
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Fig. 2C —Percutaneous renal cryoablation of renal tumor in 77-year-old
woman. Gray-scale percutaneous sonogram shows typical appearance of ice ball
with hyperechoic anterior border (arrows) and dense posterior
acoustic shadowing.
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Fig. 2D —Percutaneous renal cryoablation of renal tumor in 77-year-old
woman. Contrast-enhanced CT image obtained after cryoablation shows
low-attenuation zone of ablation (arrow) that includes RCC and margin
of normal adjacent renal parenchyma.
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Fig. 3 —Graph shows overall survival after percutaneous cryoablation
and laparoscopic renal cryoablation of solid renal masses. Dashed line
represents percutaneous group and solid line represents laparoscopic group.
Note that disease-specific survival was 100% for both groups.
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Fig. 4A —"Blind spot" during laparoscopic cryoablation of
renal tumor in 67-year-old man. Contrast-enhanced MR image obtained before
renal cryoablation shows heterogeneously enhancing right renal mass
(arrow) involving superior pole of right kidney.
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Fig. 4B —"Blind spot" during laparoscopic cryoablation of
renal tumor in 67-year-old man. Intraoperative sonogram obtained during renal
cryoablation shows heterogeneous renal cell carcinoma (RCC) with cryoprobe and
enlarging ice ball (arrow) in center of mass.
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Fig. 4C —"Blind spot" during laparoscopic cryoablation of
renal tumor in 67-year-old man. Intraoperative sonogram obtained later than
B in ablation shows that ice ball (arrows) has enlarged and
now involves all of visualized portions of RCC. However, because of extensive
posterior acoustic shadowing related to ice ball (asterisk),
posterior margin of ablation zone cannot be evaluated, resulting in
"blind spot."
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Fig. 4D —"Blind spot" during laparoscopic cryoablation of
renal tumor in 67-year-old man. Contrast-enhanced MR image obtained 1 month
after completion of laparoscopic cryoablation shows crescentic zone of
residual enhancement along medial border of RCC (arrow), which
represents residual viable tumor.
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Fig. 4E —"Blind spot" during laparoscopic cryoablation of
renal tumor in 67-year-old man. Contrast-enhanced MR image obtained 1 month
after RCC (arrow) was retreated using percutaneous cryoablation and
shows no evidence of persistent enhancement, which is consistent with complete
ablation.
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Fig. 5 —Precise monitoring of percutaneous cryoablation of renal
tumor in 62-year-old man. Unenhanced CT image obtained during percutaneous
cryoablation of right-sided renal cell carcinoma. Because ice ball (white
arrows) is so well visualized and can be closely monitored, cryoablation
can be safely performed even when there are vulnerable adjacent structures
such as colon (black arrow) as long as ice ball is not allowed to
extend to colon.
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Copyright © 2008 by the American Roentgen Ray Society.
