Orvieto Marcelo A, Zorn Kevin C, Lyon Mark B, Tolhurst Stephen R, Rapp David E, Seip Ralf, Sanghvi Narendra, Shalhav Arieh
Department of Surgery, Section of Urology, University of Chicago, Chicago, Illinois 60637, USA.
J Urol. 2009 Feb;181(2):861-6. doi: 10.1016/j.juro.2008.10.066. Epub 2008 Dec 17.
High intensity focused ultrasound for renal lesions is still experimental. In a porcine model we evaluated the safety and efficacy of a newly designed laparoscopic high intensity focused ultrasound probe and software that allows real-time ultrasound guidance during renal tissue ablation.
A Sonatherm 600 high intensity focused ultrasound system with a newly designed laparoscopic high intensity focused ultrasound probe was used through a standard Endopath 18 mm port. A total of 16 lesions were created in 15 kidneys in a total of 8 animals and randomized into 2 groups, including acute with sacrifice 4 days postoperatively and subacute with sacrifice 14 days postoperatively. Lesion size and location varied for each surgical procedure to simulate various treatment scenarios.
Mean +/- SD planned ablation volume was 7.1 +/- 5.1 cc and mean treatment time was 7.2 +/- 06.88 minutes. For all lesions an injury volume was observed with a central zone of complete necrosis and no viable tissue. Mean total injury volume was 6.5 + 3.5 cc (range 1.1 to 13.7), comparable to preoperative mean planned ablation volume (p = 0.84). Mean necrosis volume was 4.89 +/- 2.9 cc (range 0.8 to 10.5), appreciably lower than preoperative mean planned ablation volume (p = 0.33). Presence of the collecting system interposed with the treatment region did not impact the injury volume-to-planned ablation volume ratio or the necrosis volume-to-planned ablation volume ratio. No animals died before study completion. Two intraoperative complications occurred, including a back wall musculature burn and a ureteral burn.
Laparoscopic high intensity focused ultrasound for renal tissue using the newly developed probe was feasible and efficacious. The ability to perform renal high intensity focused ultrasound through an 18 mm laparoscopic port offers a new alternative for renal tumor ablation.
高强度聚焦超声用于肾脏病变仍处于实验阶段。在猪模型中，我们评估了一种新设计的腹腔镜高强度聚焦超声探头及软件的安全性和有效性，该软件可在肾脏组织消融过程中实现实时超声引导。
通过标准的Endopath 18mm端口使用配备新设计的腹腔镜高强度聚焦超声探头的Sonatherm 600高强度聚焦超声系统。在总共8只动物的15个肾脏中制造了16个病变，并随机分为2组，包括术后4天处死的急性组和术后14天处死的亚急性组。每次手术的病变大小和位置各不相同，以模拟各种治疗情况。
平均±标准差计划消融体积为7.1±5.1cc，平均治疗时间为7.2±6.88分钟。对于所有病变，均观察到损伤体积，其中心区域为完全坏死，无存活组织。平均总损伤体积为6.5 + 3.5cc（范围1.1至13.7），与术前平均计划消融体积相当（p = 0.84）。平均坏死体积为4.89±2.9cc（范围0.8至10.5），明显低于术前平均计划消融体积（p = 0.33）。治疗区域与集合系统的存在并不影响损伤体积与计划消融体积之比或坏死体积与计划消融体积之比。没有动物在研究完成前死亡。发生了2例术中并发症，包括后壁肌肉组织烧伤和输尿管烧伤。
使用新开发的探头进行腹腔镜高强度聚焦超声治疗肾脏组织是可行且有效的。通过18mm腹腔镜端口进行肾脏高强度聚焦超声的能力为肾脏肿瘤消融提供了一种新的选择。
