Computerized tomography guided percutaneous renal cryoablation with the patient under conscious sedation

When an event occurs once, we have a tendency to look at it as a phenomenon, but when it occurs twice, it begins to enter the realm of accepted reality.

To the best of my knowledge, this is only the second series on percutaneous cryoablation to be reported in the literature following Shingleton’s landmark work in this area. However, like the initial experience, these authors report a very high rate of early success (94% success rate with 16 lesions at an average follow-up of 6 months). The patients were all treated wit h a 2.4 mm cryoprobe using a double freeze technique.

The procedure time averaged 80-100 minutes and all patients were treated on an outpatient basis. Only one patient had a complication, bleeding requiring readmission and a 2 unit transfusion; however, no embolization or other invasive procedure was required. Of particular interest, five of the lesions were greater than 3 cm. with the largest being 4.6 cm; there was one failure in this group. Also, 5 of the lesions were central and the one failure was in this group (i.e. the same patient with the 4.6 cm tumor). Dr. Shingleton sagely comments: “Urologists can perform this procedure via ultrasound without radiological assistance.

The more difficult issue arises in regard to the use of computerized tomography or magnetic resonance imaging for guidance. It would be a serious mistake by the urological community to concede the procedure to radiology.” It is on this basis, that many urological practices are beginning to explore the possibility of obtaining their own CT fluoroscopy unit or creating space within the operating room for this technology.

The key question is a philosophical one: should the disease state be treated by the person who best understands the disease or by the person who has best mastered the technology? Having done the former, perhaps it is time for us to become the latter!

By Ralph V. Clayman, MD

Reference:

J. Urology 175: 447-453, February 2006

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16406968&query_hl=2&itool=pubmed_docsum

Gupta A, Allaf ME, Kavoussi LR, Jarrett TW, Chan DY, Su LM, Solomon SB.

UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.