Center for Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
J Urol. 2010 Mar;183(3):884-8. doi: 10.1016/j.juro.2009.11.042. Epub 2010 Jan 20.
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.
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.
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.
Stereotactic percutaneous cryoablation for renal tumors offers the potential for safe, precise needle placement.
经皮影像引导肿瘤消融术作为治疗肾肿瘤的微创方法，其作用日益突出。精确的冷冻探针放置是成功消融的关键。CT-Nav 是一种新型的立体定向手术导航系统，与传统的计算机断层扫描引导程序相比，它具有实现精确经皮冷冻探针放置的潜力，同时降低了辐射暴露。
我们进行了一项前瞻性试点研究，以评估该系统在肾冷冻消融术中的技术可行性、安全性和准确性。适用于肾冷冻消融的强化肾肿块患者在术前进行计算机断层扫描，并在身体上放置预先放置的跟踪传感器。使用立体红外摄像机对跟踪传感器进行三维定位，并使用跟踪手柄根据术前加载的计算机断层扫描引导经皮冷冻探针。将人口统计学和围手术期数据前瞻性地添加到机构审查委员会批准的数据库中。冷冻探针放置后立即重复计算机断层扫描以确认放置的准确性。
共对 10 例患者的 13 个肿瘤成功进行了新型导航系统冷冻消融。平均肿瘤大小为 2.2cm。术前活检显示 9 例为肾细胞癌。平均手术时间为 155 分钟。术中及术后均未发生并发症。平均住院时间为 9.5 小时。平均靶向注册误差为 4.2mm。
立体定向经皮冷冻消融治疗肾肿瘤具有安全、精确放置针头的潜力。
