Laparoscopic Cryoablation of Small Renal Masses: Technique and Results after 6-Year Experience

Abstract

Objectives Laparoscopic cryoablation (LC) has been proposed as a minimally invasive treatment option in cases of small renal masses. We describe the operative technique and the results of LC at our institution. Methods In 86 patients who underwent LC since September 2000, mean tumour size was 23.5 mm (range: 10–60). Severe comorbidities were present in 48 patients. A transperitoneal route was employed in 51 cases and a retroperitoneoscopic approach in 35 cases. Results Mean surgical time was 174.23 min, and mean “ice ball” diameter was 49.3 mm. Histology revealed renal cell carcinoma in 56 cases, 16 cases of oncocytoma, 6 cases of angiomyolipoma, 1 case of xanthogranulomatous pyelonephritis, and 7 cases were reported as “indefinite.” Intraoperative complications included two open surgical conversions and three cases of fracture of the cryoablated tissue. Postoperative complications included seven cases of hyperpyrexia, two cases of perirenal haematoma, one case of pulmonary oedema, and one case of gross haematuria. Delayed complications included one ureteropelvic junction obstruction and one case of neoplasm recurrence. The cryolesion diameter at magnetic resonance imaging on postoperative day 1 was 49.1 mm, and a progressive reduction in size of the cryoablated area was noted in all patients during the radiologic follow-up. Conclusions LC offers well-monitored renal tumour destruction, without the need of warm ischaemia time and with a reduced complication rate. Our follow-up results are promising, and the data are going to confirm the role of this surgical technique as a current clinical option for nephron-sparing surgery.