Pilot experience with transhepatic percutaneous renal cryoablation.
OBJECTIVE
Percutaneous renal cryoablation has been shown to be a feasible therapeutic option for small renal tumors. Despite advances in equipment design and imaging capabilities, tumor location can present challenges to the percutaneous approach. We present our pilot experience with transhepatic percutaneous cryoablation of right upper-pole renal tumors.


METHODS
Three patients aged 75 to 87 years with American Society of Anesthesiologists scores of III or IV underwent transhepatic percutaneous cryoablation between November 2005 and February 2006. Tumor size ranged from 2 to 5 cm. Cryoprobe placement was guided by CT imaging, and two freeze-thaw cycles were used. Additionally, 60-second freeze-thaw cycles were used to assist with hemostasis in the transhepatic tract.


RESULTS
The procedure was completed percutaneously in all cases with the patient under conscious sedation. The procedure time ranged from 67 to 167 minutes. Postoperative pain was managed with minimal use of nonnarcotic oral medications. Although one patient developed a moderate perinephric hematoma and required a blood transfusion, no hepatic complications were manifest. Local treatment failure was evident in one patient with a 5-cm mass showing enhancement at follow-up imaging.


CONCLUSIONS
Transhepatic access for percutaneous cryoablation of renal tumors is feasible. Limitations include tumor size, as larger tumors may introduce prohibitive risks.
Malcolm
John B
JB
Department of Urology, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA.
Gold
Robert
R
Derweesh
Ithaar H
IH
D000005:Abdomen / Q000473:pathology; D000368:Aged; D000369:Aged, 80 and over; D018207:Angiomyolipoma / Q000000981:diagnostic imaging / Q000473:pathology; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D003287:Contrast Media; D003452:Cryosurgery / Q000379:methods*; D003710:Demography; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D010865:Pilot Projects; D014057:Tomography, X-Ray Computed
D003287:Contrast Media