Rebuck David A, Nadler Robert B, Perry Kent T
Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
Can J Urol. 2012 Feb;19(1):6094-9.
To assess the technical feasibility and safety of trajectory image-guided percutaneous renal cryoablation in a porcine model.
Six pigs (12 kidneys) were utilized. Only the posterior and lateral regions of the kidneys were considered. A bone-anchored dynamic reference frame (DRF) was inserted into the iliac crest and the O-Arm and StealthStation TREON System (OASSTS, Medtronic, CO, USA) was used to acquire 3-dimensional (3D) imaging of the kidneys. A hand-held pointing device was crafted from a cryoablation needle (Galil Medical, MN, USA) and an optical reference frame. The hand-held pointer/cryoablation needle ("cryoprobe") was then optically recognized by the OASSTS. The cryoprobe was then used to navigate its tip into a randomly chosen renal region of interest using 3D trajectory images. Two freeze-thaw cryoablation cycles were then performed. We assessed treatment times and effective radiation doses. We also assessed concordance between projected iceball location on trajectory imaging and cryolesion location on necropsy.
The mean total treatment time was 24.0 minutes. The mean effective radiation dose was 23.7 mSv per kidney treated. The trajectory-guided images used to place the cryoprobe tips into the renal region of interest agreed with the necropsy-determined location of the cryolesion in all cases. Injury to a lumbar muscle and a renal pelvis were observed in two separate cases, respectively.
Trajectory image-guided percutaneous renal cryoablation using OASSTS is technically feasible, appears safe, and is associated with acceptable levels of radiation exposure. Comparison of trajectory image-guidance and cryolesions on necropsy demonstrated concordant needle placement.
评估在猪模型中经皮肾冷冻消融术轨迹图像引导的技术可行性和安全性。
使用6头猪（12个肾脏）。仅考虑肾脏的后侧和外侧区域。将骨锚定动态参考框架（DRF）插入髂嵴，使用O型臂和StealthStation TREON系统（OASSTS，美敦力公司，美国科罗拉多州）获取肾脏的三维（3D）成像。用冷冻消融针（美国明尼苏达州Galil Medical公司）和光学参考框架制作一个手持式指示装置。然后OASSTS对手持式指示针/冷冻消融针（“冷冻探头”）进行光学识别。接着使用冷冻探头，通过3D轨迹图像将其尖端导航至随机选择的肾脏感兴趣区域。然后进行两个冻融冷冻消融周期。我们评估了治疗时间和有效辐射剂量。我们还评估了轨迹成像上预测的冰球位置与尸检时冷冻损伤位置之间的一致性。
平均总治疗时间为24.0分钟。每个接受治疗的肾脏平均有效辐射剂量为23.7毫希沃特。用于将冷冻探头尖端放置到肾脏感兴趣区域的轨迹引导图像在所有病例中均与尸检确定的冷冻损伤位置一致。在两个不同病例中分别观察到腰大肌和肾盂损伤。
使用OASSTS进行轨迹图像引导的经皮肾冷冻消融术在技术上是可行的，似乎是安全的，并且辐射暴露水平可接受。轨迹图像引导与尸检时冷冻损伤的比较显示针放置位置一致。
