Gill I S, Novick A C, Soble J J, Sung G T, Remer E M, Hale J, O'Malley C M
Department of Urology, and the Minimally Invasive Surgery Center, The Cleveland Clinic Foundation, Ohio 44195, USA.
Urology. 1998 Oct;52(4):543-51. doi: 10.1016/s0090-4295(98)00309-4.
To present the technique and short-term results of retroperitoneal laparoscopic renal cryoablation.
Ten patients underwent laparoscopic renal cryoablation of 11 exophytic renal tumors ranging in size from 1.5 to 3 cm identified on computed tomography. Tumors were located at the upper (3), middle (5), or lower (3) pole of the kidney. Three patients had a solitary kidney. A 3-port retroperitoneal laparoscopic approach was used to create renal cryolesions. Puncture cryoablation was performed with a 4.8-mm cryoprobe. Real-time, endoscopic, steerable, color Doppler ultrasound was used to monitor the evolving cryolesion. All patients have completed a minimum follow-up of 3 months (mean 5.5, range 3 to 9).
Cryoablation was technically successful in all 10 patients (11 tumors). Under ultrasound guidance, the ice ball was intentionally created up to 1 cm beyond the tumor edge with the aim of achieving negative margins. Mean surgical time was 2.4 hours, cryoablation (double freeze-thaw) time 12.9 minutes, cryoprobe tip temperature -186 degrees C, and blood loss 75 mL. Systemic temperature remained unaltered. Hospital stay was less than 23 hours in 9 of 10 patients. Follow-up magnetic resonance imaging at 1 day and 1, 2, and 3 months identified the punched-out, nonenhancing, spontaneously resorbing, renal cryolesion. Follow-up biopsies of the cryoablated tumor site were negative for cancer in the 3 patients who have undergone the biopsy.
The initial series of laparoscopic renal cryoablation is presented. The retroperitoneoscopic approach, by avoiding the peritoneal cavity, minimizes the chances of the bowel coming in contact with the evolving cryolesion, and the potential sequelae thereof. Laparoscopic renal cryoablation is currently developmental and long-term data are awaited. Nevertheless, it is potentially an attractive addition to available nephron-sparing surgical techniques.
介绍腹膜后腹腔镜肾冷冻消融术的技术及短期结果。
10例患者接受了腹腔镜肾冷冻消融术，对计算机断层扫描发现的11个外生性肾肿瘤进行治疗，肿瘤大小为1.5至3厘米。肿瘤位于肾上极（3个）、肾中极（5个）或肾下极（3个）。3例患者为单肾。采用三通道腹膜后腹腔镜入路创建肾冷冻灶。使用4.8毫米冷冻探头进行穿刺冷冻消融。采用实时、内镜、可操控、彩色多普勒超声监测冷冻灶的形成过程。所有患者均完成了至少3个月的随访（平均5.5个月，范围3至9个月）。
10例患者（11个肿瘤）的冷冻消融术在技术上均获成功。在超声引导下，有意将冰球创建至超出肿瘤边缘1厘米处，以实现切缘阴性。平均手术时间为2.4小时，冷冻消融（双冻融）时间为12.9分钟，冷冻探头尖端温度为-186℃，失血量为75毫升。全身温度未发生改变。10例患者中有9例住院时间少于23小时。术后1天、1个月、2个月和3个月的随访磁共振成像显示出肾冷冻灶呈凿孔状、无强化、可自发吸收。3例接受活检的患者，其冷冻消融肿瘤部位的随访活检结果均为癌症阴性。
展示了腹腔镜肾冷冻消融术的初步系列病例。腹膜后腹腔镜入路通过避免进入腹腔，最大限度地减少了肠管与正在形成的冷冻灶接触的机会及其潜在后遗症。腹腔镜肾冷冻消融术目前仍在发展中，有待长期数据。然而，它可能是现有保留肾单位手术技术中一个有吸引力的补充。
