Enhanced renal parenchymal cryoablation with novel 17-gauge cryoprobes

Ames, Caroline D.; Vanlangendonck, Richard; Venkatesh, Ramakrishna; Gonzales, Froylan C; Quayle, Sejal S.; Yan, Yan; Humphrey, Peter A.; Landman, Jaime

doi:10.1016/j.urology.2004.02.033

Cited by 23 publications

(6 citation statements)

References 4 publications

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“…These ultrathin cryoprobes are easily introduced into the kidney, minimize bleeding from the puncture tract and reduce the risk of renal fracture [3]. Although different ice ball sizes are available, the ablation zone achieved is smaller and therefore multiple cryoprobes [4], acting synergistically, need to be inserted [5]. The clinical safety of ultrathin cryoprobes is proven [6] but concerns about their efficacy might still exist.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic renal cryoablation using ultrathin 17‐gauge cryoprobes: mid‐term oncological and functional results

et al. 2010

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• Survival data were analysed using the Kaplan-Meier method. Best estimates for the overall survival (OS), recurrence-free survival (RFS), cancer-specific survival (CSS) and metastatic-free survival (MFS) were made for patients with renal cell carcinoma (RCC) and for patients with RCC or non-diagnostic biopsy. RESULTS• A total of 92 patients (100 tumours; mean size 2.5 ± 0.8 cm) were treated in 95 sessions. The mean follow-up was 30.2 ± 16.6 months (Mean values are ± SD).• Intraoperative biopsy showed RCC in 51 patients (53.7%), benign lesion in 23 patients (24.2%) and was non-diagnostic in 21 patients (22.1%). Three tumour persistences and four radiological recurrences were detected.• The estimated mean RFS time and 3-year OS and RFS in patients with RCC exclusively were 47.8 (95% confidence interval [CI]: 44.1-51.1) months, 86.1% (95% CI: 71.2-93.6) and 91.8% (95% CI: 76.3-97.3), respectively. The figures were slightly higher in the group of patients with RCC or unknown pathology. The actual CSS and MFS rates were 100%.• Renal function was preserved in 84.5% of patients with normal preoperative eGFR.• Baseline eGFR was the only predictor of renal insufficiency development at 1-year follow-up. CONCLUSIONLaparoscopic cryoablation with multiple ultrathin cryoprobes is oncologically and functionally effective at mid-term follow-up. KEYWORDS cryoablation, kidney, renal cancer, laparoscopy, survivalWhat's known on the subject? and What does the study add? Laparoscopic Cryoablation of renal masses has a low persistence and recurrence rates at short term follow-up albeit higher than Partial Nephrectomy. Long term results are scarcely reported. It is however a NSS technique suitable for high-risk that preserves renal function.The study provides (1) mid-term oncological outcomes of laparoscopic cryoablation of renal masses stratified by primary pathology (RCC, benign mass or undetermined biopsy) and (2) data on renal function evolution up to one year of follow-up supporting the fact that the only predictor of (moderate)renal insufficiency development after Laparoscopic cryoablation is the eGFR at baseline.Study Type -Therapy (case series) Level of Evidence 4

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Section: Introductionmentioning

confidence: 99%

Laparoscopic renal cryoablation using ultrathin 17‐gauge cryoprobes: mid‐term oncological and functional results

et al. 2010

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“…The main advantage of this system is to measure temperatures at various points in a longitudinal axis, which will allow the surgeon a better assessment of the adequacy of treatment. New cryoneedles (IceRods TM , Oncura, Amersham, Bucks, UK) have been developed which have an advanced heat exchanger with an extended area of heat exchange, resulting in a precise ice-ball that is comparable in size to that with larger diameter cryoneedles [11]. The expected result is a larger ice-ball at lower temperatures.…”

Section: Introductionmentioning

confidence: 99%

Cryotherapy for the prostate: an in vitro and clinical study of two new developments; advanced cryoneedles and a temperature monitoring system

Gowardhan

Greene

2007

BJU International

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temperatures throughout the procedure were recorded accurately and analysed. RESULTSThe IceRods were better able to freeze tissue, reaching lower temperatures than conventional cryoneedles. The IceRods were also capable of forming ice-balls with a maximum diameter of > 6 cm after freezing at full power for 10 min. The TMS probes depicted real-time temperature gradients over either four or eight points in a linear array, enabling more thorough monitoring of the temperature changes during a treatment cycle. In the clinical setting, in all 20 patients, therapeutic freezing of <− 40 ° C was achieved in both the cycles. Temperatures of ≈ − 40 ° C were attained in the area just outside the prostate, as measured by the TMS probes, but with variation along the longitudinal axis. The rectal and external urinary sphincter temperatures did not fall below 0 ° C at any of the points along the eight-point temperature probe, but there was variation in temperature along the prostate. CONCLUSIONIceRods and the TMS probes are clinically useful, requiring fewer cryoneedles and with more efficient temperature monitoring; this would be expected to reduce morbidity and increase safety without compromising an adequate oncological outcome. The IceRods were useful in larger prostates of > 3.5 cm long, which obviated the need for a 'pull-back' technique. The TMS probes showed convincingly the variation in temperatures along one line, suggesting that single-point temperature monitoring might not accurately depict the lowest temperatures reached during treatment, which is particularly important in the rectum. This is a significant development in cryosurgery and would make the procedure safer, reproducible and allow interested clinicians to learn the technique safely and more quickly.

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“…As the 3.4‐mm and the 1.47‐mm probes have been shown to produce ice‐balls and areas of complete ablation that are similar in volume [9], it seems likely that the cause of the renal parenchymal fracture and bleeding was mechanical trauma to the tissue and ice‐ ball from the larger cryoablation probes. Mechanical trauma, rather than intrinsic ice‐ball fractures, as a source of bleeding in this setting is supported by our laboratory experience with the larger 3.4‐mm cryoprobes.…”

Section: Discussionmentioning

confidence: 99%

Risk factors associated with renal parenchymal fracture during laparoscopic cryoablation

Hruby¹,

Edelstein²,

Karpf³

et al. 2008

BJU International

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OBJECTIVE To assess the risk factors for haemorrhage and renal fracture associated with renal cryoablation. MATERIALS AND METHODS In a porcine model, 120 cryoablations were administered in 26 pigs, with five groups of 24 ice‐balls each; in groups 1 and 2 asynchronous cryoprobe activation was evaluated for the 1.47‐ and 3.4‐mm cryoprobes (IceRods, Galil Medical, Plymouth Meeting, PA, USA), respectively; in group 3, three‐3.4 mm cryoprobes were used to examine synchronous probe activation; in group 4 the 1.47‐mm cryoprobe was used to examine single‐probe activation with premature cryoprobe extraction; and in group 5 we used a new ‘guillotine’ technique for upper‐pole renal cryoablation. Ice‐ball fractures and haemorrhage were characterized by the location, length and depth of each fracture, was well as the degree of bleeding. RESULTS In all, 26 domestic pigs successfully had renal cryoablation procedures. In group 1 and 4 there were no episodes of renal fracture; in group 2 renal fracture occurred in 10 (42%) trials. Group 3 had 22 (92%) renal fractures during the freeze/thaw cycle. Group 5 had 13 (54%) renal fractures during the freeze/thaw cycle, and there was an additional ice‐ball fracture during probe removal once in 24 times. CONCLUSIONS Renal fracture is most common with the application of larger 3.4‐mm cryoprobes in the synchronous and asynchronous setting. Under standard application, smaller (1.47‐mm) cryoprobes result in little renal fracture or bleeding. The use of the guillotine technique is associated with a greater risk of renal fracture.

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Enhanced renal parenchymal cryoablation with novel 17-gauge cryoprobes

Cited by 23 publications

References 4 publications

Laparoscopic renal cryoablation using ultrathin 17‐gauge cryoprobes: mid‐term oncological and functional results

Laparoscopic renal cryoablation using ultrathin 17‐gauge cryoprobes: mid‐term oncological and functional results

Cryotherapy for the prostate: an in vitro and clinical study of two new developments; advanced cryoneedles and a temperature monitoring system

Risk factors associated with renal parenchymal fracture during laparoscopic cryoablation

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