Early Experience with Laparoscopic Cryoablation in Patients with Small Renal Tumors and Severe Comorbidities

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Abstract
To present our preliminary experience with laparoscopic renal cryoablation in patients with small renal tumors and severe comorbidities. Eight patients with a mean age of 75.6 years (range 68-82 years) who had small (mean 2.6+/-0.7-cm; range 1.4-3.8-cm) peripheral renal cortical lesions and significant comorbidities underwent laparoscopic cryoablation with a 3-mm cryoprobe. None of the patients was considered a good candidate for extirpative surgery. Tumors were biopsied prior to cryoablation. Intraoperative laparoscopic ultrasonography was utilized to confirm the tumor and to monitor the biopsy and the cryoablation process. Most patients had right-sided tumors, although there were no significant differences in the approach or outcome on this basis. Seven patients had intraoperative biopsies, and in all cases, good tissue samples were obtained. There were no intraoperative or postoperative complications. The average blood loss was 102.5+/-123.3 mL, and the mean operative time was 120+/-27.8 minutes. The mean hospital stay was 2.9+/-1.6 days. Postoperative imaging demonstrated defects consistent with ablation of the affected area; however, a residual nonenhancing mass defect usually was demonstrated. Laparoscopic cryoablation appears to be safe for the treatment of solid or complex renal masses in elderly patients with severe comorbidities. Further studies are necessary to determine the long-term efficacy before this modality can be considered an acceptable curative treatment for small renal cortical tumors.