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Laparoscopic Cryoablation of Renal Tumors: Assessment of Learning Curve and Outcomes in a Low Volume Practice
Journal article   Open access   Peer reviewed

Laparoscopic Cryoablation of Renal Tumors: Assessment of Learning Curve and Outcomes in a Low Volume Practice

Stephen M Anderson and James A Brown
Current urology, Vol.4(2), pp.81-84
05/2010
DOI: 10.1159/000253417
url
https://doi.org/10.1159/000253417View
Published (Version of record) Open Access

Abstract

Objective: To assess the learning curve and outcomes of a low volume practice of laparoscopic renal tumor cryoablation. Patients and Methods: Five patients with 1.5–3.5 cm renal tumor(s) underwent laparoscopic renal tumor cryoablation by a single surgeon between August 2005 and May 2007 (3 cases/year average). Two and 3 cases were performed using the Endocare system and the Galil (formerly Oncura) cryoablation system, respectively. Intraoperative ultrasound tumor localization was performed. Two retroperitoneoscopic, 2 standard and 1 hand-assisted laparoscopic, in a tuberous sclerosis patient with multiple tumors, procedures were performed. Age, operative time, estimated blood loss, complications, transfusions, biopsy pathology findings, hospitalization, computerized tomography findings, and serum creatinine levels were recorded. Results: Mean patient age was 49 years (range 13–65 years). Mean tumor size was 2.6 cm (1.5–3.5 cm). All cryoablations were completed successfully. One patient was converted due to severe perinephric fibrosis after prior renal surgery. Excluding the hand-assisted laparoscopic procedure, mean operative time was 193.5 minutes (range 141–237 minutes). Complications included a small renal capsular tear (in the patient with severe perinephric fibrosis), a small peri-ureteral vein laceration and left arm phlebitis. Renal biopsy pathology included clear cell carcinoma, papillary carcinoma (2 patients), angiomyolipoma and tubular epithelial atypia suspicious for neoplasia. Mean hospital stay was 2 days (range 1–3 days). Serum creatinine returned to baseline in all patients. No patient has demonstrated local recurrence or metastases to date. Conclusions: Laparoscopic renal tumor cryoablation can be safely and effectively performed at a low frequency (<3 cases/year) with good results and no significant surgeon learning curve.
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