ENDOUROLOGY & LAPAROSCOPY

Intermediate Results of Laparoscopic Cryoablation in 59 Patients at the Medical College of Wisconsin
Lawatsch EJ, Langenstroer P, Byrd GF, See WA, Quiroz FA, Begun FP
Departments of Urology and Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
J Urol. 2006; 175: 1225-9; discussion 1229

• Purpose: We report our experience with LC for small renal tumors.
• Materials and Methods: Patients who underwent LC at our institution between February 2000 and September 2004 were included in the study. A retrospective chart review was done for perioperative and postoperative parameters as well as clinical outcomes.
• Results: A total of 65 LCs were performed in 59 patients during the period reviewed. Overall 81 renal tumors were cryoablated. Median patient age was 62 years. Median tumor size was 2.5 cm. Median operative time was 190 minutes. Median estimated blood loss was 50 ml. Median hospital stay was 2 days. Conversion to open surgery occurred in 2 patients. Nephrectomy for bleeding occurred in 1 patient. Median followup was 26.8 months. Two recurrences were identified after LC.
• Conclusions: LC is an alterative modality to laparoscopic partial nephrectomy or open partial nephrectomy for small renal tumors. Tumor recurrence rates in the studies published to date are comparable to those of partial nephrectomy, although longer followup is needed.
  
  
• Editorial Comment
  Laparoscopic cryoablation of small renal tumors is still in development. The new cryo probes have increased the efficiency of cytotoxic effects to treat the renal lesions and decreased the rate of complications. So far, the technology has demonstrated to be efficient to treat renal tumors. The authors concluded that laparoscopic cryoablation is a potential alternative modality to laparoscopic partial nephrectomy or open partial nephrectomy for small renal tumors but the cryoablation technique requires a basic skill set in laparoscopic surgery, which makes this technique appealing for less experienced laparoscopic surgeons. Moreover, laparoscopic cryoablation may be associated with decreased risks of bleeding and urine leakage in comparison to laparoscopic partial nephrectomy. Future comparative studies are needed to fully validate this technique but initial reports of oncological control are encouraging.

Dr. Fernando J. Kim
Chief of Urology, Denver Health Med Ctr
Assistant Professor, Univ Colorado Health Sci Ctr
Denver, Colorado, USA