title: The UCI Seldinger technique for percutaneous renal cryoablation: protecting the tract and achieving hemostasis.
abstract: OBJECTIVE
  To describe our Seldinger technique of percutaneous renal cryoablation that was devised to facilitate renal biopsy, cryoprobe placement, and instillation of adjunctive hemostatics while protecting surrounding tissues from cryoinjury.
  
  
  METHODS
  This approach was used to manage 13 renal masses in 12 adult patients. Under CT-fluoroscopic guidance, an access needle was inserted to abut the surface of the tumor, followed by an Amplatz super-stiff guidewire and a customized coaxial catheter system, which was used as a conduit for needle biopsy, cryoprobe insertion, and FloSeal instillation. In addition, a porcine model was used to compare the temperature readings adjacent to the sheathed and the unsheathed cryoprobe during percutaneous renal cryoablation.
  
  
  RESULTS
  In all patients, the use of this access approach was accomplished without incident. Two patients needed blood transfusions. No patient had significant skin, muscle, or nerve debility. At a mean follow-up of 11 months, none had evidence of persistent disease on CT or MRI contrast imaging. In the porcine model, the customized sheath protected the surrounding tissues from reaching temperatures below 5 degrees C while temperatures down to -15 degrees C were obtained when no insulating sheath was used.
  
  
  CONCLUSIONS
  A modified Seldinger technique enabled us to perform percutaneous renal cryotherapy through a single access channel, which facilitated access for biopsy, cryoprobe placement, and instillation of hemostatic agents. This approach may provide a protective barrier against cryogenic damage to neighboring tissues and could theoretically help minimize the chance of tract seeding.
authors.affiliation: Department of Urology, University of California, Irvine, Irvine, California 92868, USA.
authors.forename: Jose Benito A
authors.initials: JB
authors.lastname: Abraham
authors.forename: Aldrin Joseph R
authors.initials: AJ
authors.lastname: Gamboa
authors.forename: David S
authors.initials: DS
authors.lastname: Finley
authors.forename: Shawn M
authors.initials: SM
authors.lastname: Beck
authors.forename: Hak J
authors.initials: HJ
authors.lastname: Lee
authors.forename: Ricardo J S
authors.initials: RJ
authors.lastname: Santos
authors.forename: Geoffrey N
authors.initials: GN
authors.lastname: Box
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Deane
authors.forename: Duane J
authors.initials: DJ
authors.lastname: Vajgrt
authors.forename: Elspeth M
authors.initials: EM
authors.lastname: McDougall
authors.forename: Ralph V
authors.initials: RV
authors.lastname: Clayman
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D002140:California; D003452:Cryosurgery / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006487:Hemostasis; D006801:Humans; D007668:Kidney / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D034421:Sus scrofa; D013696:Temperature; D014495:Universities