Stereotactic percutaneous cryoablation for renal tumors: initial clinical experience.
OBJECTIVE
Percutaneous imaging guided tumor ablation has an increasingly prominent role as minimally invasive treatment for renal tumors. Precise cryoprobe placement is essential for successful ablation. CT-Nav is a novel stereotactic surgical navigation system with the potential to achieve precise percutaneous cryoprobe placement while decreasing radiation exposure compared to conventional computerized tomography guided procedures.


METHODS
We performed a prospective pilot study to evaluate the technical feasibility, safety and accuracy of the system during renal cryoablation. Patients with enhancing renal masses amenable to renal cryoablation underwent preoperative computerized tomography with a preplaced tracking sensor taped to the body. Using a stereroscopic infrared camera the tracking sensor was located 3-dimensionally and a tracking handle was used to guide the cryoprobe percutaneously based on preoperative preloaded computerized tomography. Demographic and perioperative data were added prospectively to an institutional review board approved database. Immediately after cryoprobe placement computerized tomography was repeated to confirm placement accuracy.


RESULTS
A total of 13 tumors in 10 patients were successfully cryoablated with the novel navigational system. Mean tumor size was 2.2 cm. Preoperative biopsy revealed renal cell carcinoma in 9 cases. Mean operative time was 155 minutes. No intraoperative or postoperative complications were noted. Mean length of stay was 9.5 hours. Mean targeting registration error was 4.2 mm.


CONCLUSIONS
Stereotactic percutaneous cryoablation for renal tumors offers the potential for safe, precise needle placement.
Haber
Georges-Pascal
GP
Center for Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Crouzet
Sebastien
S
Remer
Erick M
EM
O'Malley
Charles
C
Kamoi
Kazumi
K
Goel
Raj
R
White
Wesley M
WM
Kaouk
Jihad H
JH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003452:Cryosurgery / Q000379:methods*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D013238:Stereotaxic Techniques