title: Laparoscopic renal cryoablation in 32 patients.
abstract: OBJECTIVE
  Laparoscopic renal cryoablation is a developmental minimally invasive nephron-sparing treatment alternative for highly select patients with small renal tumors. We present our evolving experience with this procedure.
  
  
  METHODS
  Thirty-two patients (34 tumors) with a mean tumor size of 2.3 cm on preoperative computed tomography underwent laparoscopic renal cryoablation. As dictated by the tumor location, cryoablation was performed by either the retroperitoneal (n = 22) or the transperitoneal (n = 10) laparoscopic approach using real-time ultrasound monitoring. A double freeze-thaw cycle was routinely performed.
  
  
  RESULTS
  The mean surgical time was 2.9 hours, cryoablation time 15.1 minutes, and blood loss 66.8 mL. For a mean intraoperative ultrasonographic tumor size of 2 cm, the mean cryolesion size was 3.2 cm. The hospital stay was less than 23 hours in 22 (69%) of 32 patients. Sequential magnetic resonance imaging scans demonstrated a gradual contraction in the mean diameter of the cryolesions. Of the 20 patients who underwent a 1-year follow-up magnetic resonance imaging scan, the cryoablated tumor was no longer visible in 5. Of note, 23 patients have now undergone a 3 to 6-month follow-up computed tomography-directed biopsy of the cryoablated tumor site; the biopsy was negative for cancer in all 23 patients. No evidence of local or port-site recurrence was found during a mean follow-up of 16.2 months.
  
  
  CONCLUSIONS
  Critical long-term data regarding laparoscopic renal cryoablation, a developmental technique, are awaited. However, our initial experience is cautiously optimistic. Despite its significant potential for false-negative results, it is encouraging that the follow-up computed tomography-directed needle biopsies at 3 to 6 months were negative for cancer in 23 of 23 patients.
authors.affiliation: Section of Laparoscopic and Minimally Invasive Surgery, Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: I S
authors.initials: IS
authors.lastname: Gill
authors.forename: A C
authors.initials: AC
authors.lastname: Novick
authors.forename: A M
authors.initials: AM
authors.lastname: Meraney
authors.forename: R N
authors.initials: RN
authors.lastname: Chen
authors.forename: M G
authors.initials: MG
authors.lastname: Hobart
authors.forename: G T
authors.initials: GT
authors.lastname: Sung
authors.forename: J
authors.initials: J
authors.lastname: Hale
authors.forename: D K
authors.initials: DK
authors.lastname: Schweizer
authors.forename: E M
authors.initials: EM
authors.lastname: Remer
mesh_terms: D018249:Adenoma, Oxyphilic / Q000175:diagnosis / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D003452:Cryosurgery / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007432:Intraoperative Period; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography