A Novel Approach to Energy Ablative Therapy of Small Renal Tumours: Laparoscopic High-Intensity Focused Ultrasound

Klingler, H. Christoph; Susani, Martin; Seip, R.; Mauermann, Julian; Sanghvi, N. T.; Marberger, Michael

doi:10.1016/j.eururo.2007.11.020

Cited by 113 publications

(81 citation statements)

References 25 publications

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“…Treatment targeting was accurate and the ablated tissue was always within the targeted area. However, concerns have been raised about skipping lesions within treated areas [21]. In our series, there was evidence of subcapsular skipping in two patients.…”

Section: Discussionmentioning

confidence: 82%

“…Patients were assessed regularly for evidence of any complications and serum creatinine levels were monitored daily for at least 3 days. Patients were followed for a mean (range) of 15 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) months. Routine postoperative cross-sectional imaging was undertaken at 3 months to assess for evidence of disease recurrence or metastasis and then 6-monthly or annually thereafter.…”

Section: Specimen Analysismentioning

confidence: 99%

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Laparoscopic high‐intensity focused ultrasound for renal tumours: a proof of concept study

et al. 2010

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Study Type – Therapy (case series) Level of Evidence What’s known on the subject? and What does the study add? Renal cancer is increasingly diagnosed when tumours are small and asymptomatic, during routine abdominal imaging. Whilst surgery is an effective and potentially curative option, it carries a significant risk of complications. Recent work suggests that thermally ablative therapies (RFA, cryotherapy, HIFU) may be suitable minimally invasive treatment options in selected patients. The success of extracorporeal HIFU has been limited by the abdominal wall and rib‐cage limiting energy delivery. For this study, a purpose‐built laparoscopic HIFU probe was designed to allow direct application of the transducer to the tumour surface, thus facilitating tumour destruction. Successful and accurate tumour destruction was demonstrated, paving the way for further clinical trials, subject to device modifications. OBJECTIVE To test and establish clinical proof of concept for a laparoscopic high‐intensity focused ultrasound (HIFU) device that facilitates delivery of ultrasound by direct application of a probe to the tumour surface. PATIENTS AND METHODS Twelve patients with renal tumours were treated with laparoscopic HIFU using a newly designed probe inserted via an 18‐mm laparoscopic port. HIFU treatment was targeted at a pre‐defined proportion of the tumour and immediate laparoscopic partial or radical nephrectomy was then performed. RESULTS No tumour ablation was seen in the first five patients which made modifications in the treatment protocol necessary. After this, definite histological evidence of ablation was seen in the remaining seven patients. The ablated zones were within the targeted area in all patients and no intra‐lesional skipping was seen. Subcapsular skipping was seen at the probe–tumour interface in two patients with viable tumour cells seen at microscopy. One patient did not undergo surgical extirpation; subsequent biopsy revealed no viable tumour cells. There were no intraoperative or postoperative complications directly related to HIFU therapy and patients have reached a mean (range) follow‐up of 15 (8–24) months with no evidence of metastatic disease or late complications. CONCLUSIONS Tumour ablation with laparoscopic HIFU is feasible. Homogenous ablation can be achieved with no vital tissue within the targeted zone. The technique is associated with low morbidity and may have a role in the definitive management of small tumours.

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Section: Discussionmentioning

confidence: 82%

Section: Specimen Analysismentioning

confidence: 99%

Laparoscopic high‐intensity focused ultrasound for renal tumours: a proof of concept study

et al. 2010

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“…Ocho MRP (tamaño medio 22mm) fueron tratadas con HIFU y posteriormente extirpadas, observando en la mayoría de ellas necrosis térmica 35 . Esta innovación promete que la depuración de la técnica en un futuro se valore como otra alternativa de tratamiento mínimamente invasivo para la MRP, aunque en la actualidad se considere una técnica experimental.…”

Section: Hifu Guiado Por Laparoscopiaunclassified

Papel de la laparoscopia ante la masa renal menor de 4 cm

Briones

Zarranz

Escrig

2009

Actas Urológicas Españolas

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N adie cuestiona en 2008 que la vía de elección para la exéresis de una glándula suprarrenal es la laparoscopia 1 . Tampoco se discute el cambio en la cirugía renal que ha supuesto la nefrectomía radical laparoscópica 2 . Por otro lado, todos estamos viviendo el incremento exponencial del diagnóstico de masas renales pequeñas (MRP) 3 , entendiendo éstas como aquellas menores de 4cm influenciados por el TNM y por la necesidad de un consenso en su definición. Original Papel de la laparoscopia ante la masa renal menor de 4 cmJosé Rubio Briones*, Javier Estébanez Zarranz**, J.L. Domínguez Escrig*** ResumenEl incremento en el diagnóstico incidental de masas renales pequeñas (MRP) -menores de 4cm-ha obligado a considerar tratamientos mínimamente invasivos para las mismas, sobre todo por el alto porcentaje de patologías no malignas indistinguibles de las tumorales radiológicamente. El acceso laparoscópico ha cobrado por tanto una importancia capital en el manejo de dichas masas, en un intento de disminuir la morbilidad de la lumbotomía.La nefrectomía parcial laparoscópica (NPL) es una técnica en evolución en la mayoría de centros que por un lado compite con la nefrectomía parcial abierta como técnica de elección y por otro lado competirá en un futuro con las técnicas no exeréticas. Estas también se han podido desarrollar de una manera más precisa gracias a la laparoscopia.En este artículo pretendemos, basándonos en una revisión estandarizada de la prolífica literatura a cerca del tratamiento de la MRP, revisar las innovaciones tecnológicas y las mejoras técnicas que la vía de abordaje laparoscópica nos va deparando, no solo como técnica exerética, sino como vehículo de tratamientos mínimamente invasivos, remarcando también los requerimientos de los Servicios de Urología y las mejoras que podrían hacerse en los sistemas sanitarios para que la NPL ganara terreno en el tratamiento de la MRP.La progresiva depuración de la técnica y la mejora del arsenal laparoscópico y de agentes hemostasiantes van a incrementar la indicación de NPL en un futuro. La escasa frecuencia de la patología y la necesidad de optimizar la técnica, obligarían a los responsables sanitarios a centralizar esta patología en centros con experiencia en laparoscopia y en nefrectomía parcial abierta. Role of laparoscopy in the presence of a renal mass under 4 cm in size AbstractThe increasingly common incidental diagnosis of small renal masses (SRMs)(measuring under 4 cm in size) has led to the consideration of applying minimally invasive techniques to deal with them -particularly in view of the high percentage of non-malignant conditions of this size that are radiologically indistinguishable from tumor lesions. Accordingly, laparoscopic access has gained great importance in the management of these masses, in an attempt to lessen the morbidity associated with lumbotomy.Laparoscopic partial nephrectomy (LPN) is an evolving technique in most centers; on one hand it competes with open partial nephrectomy as the technique of choice, and on the other it will c...

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“…In sufficient quantities, the heat and displacement can destroy tissue. This means that sufficiently intense focused ultrasound-known as HIFU for "high intensity focused ultrasound"-is a promising therapeutic modality (Illing et al, 2005;Klinger et al, 2008;Park et al, 2009). However, in lesser amounts, iFU has induced discernable sensations in human subjects (Gavrilov et al, 1977a,b;Gavrilov et al, 1996;Dalecki et al, 1995;Wright et al 2002;Dickey et al, 2012).…”

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confidence: 99%

Rapid ultrasonic stimulation of inflamed tissue with diagnostic intent

McClintic

Dickey

Illian

et al. 2013

The Journal of the Acoustical Society of America

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Previous studies have observed that individual pulses of intense focused ultrasound (iFU) applied to inflamed and normal tissue can generate sensations, where inflamed tissue responds at a lower intensity than normal tissue. It was hypothesized that successively applied iFU pulses will generate sensation in inflamed tissue at a lower intensity and dose than application of a single iFU pulse. This hypothesis was tested using an animal model of chronic inflammatory pain, created by injecting an irritant into the rat hind paw. Ultrasound pulses were applied in rapid succession or individually to rats' rear paws beginning at low peak intensities and progressing to higher peak intensities, until the rats withdrew their paws immediately after iFU application. Focused ultrasound protocols consisting of successively and rapidly applied pulses elicited inflamed paw withdrawal at lower intensity and estimated tissue displacement values than single pulse protocols. However, both successively applied pulses and single pulses produced comparable threshold acoustic dose values and estimates of temperature increases. This raises the possibility that temperature increase contributed to paw withdrawal after rapid iFU stimulation. While iFU-induction of temporal summation may also play a role, electrophysiological studies are necessary to tease out these potential contributors to iFU stimulation.

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A Novel Approach to Energy Ablative Therapy of Small Renal Tumours: Laparoscopic High-Intensity Focused Ultrasound

Cited by 113 publications

References 25 publications

Laparoscopic high‐intensity focused ultrasound for renal tumours: a proof of concept study

Laparoscopic high‐intensity focused ultrasound for renal tumours: a proof of concept study

Papel de la laparoscopia ante la masa renal menor de 4 cm

Rapid ultrasonic stimulation of inflamed tissue with diagnostic intent

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