Definition: cryoablation and radiofrequency ablation are two techniques by which renal tumors can be destroyed today. The concept of ablation is relatively new surgery for cancer of any disease. Traditionally, surgeons have treated cancer literally extirpates. In contrast to this approach, ablation is a different concept that cold energy or heat is used to destroy cancerous tissue in the exact place where there is in the body. Ablation has been used for many types of cancer: lung, liver and prostate. However, the technology is particularly suitable for kidney cancer (kidney cancer).
The two currently available technologies that are FDA approved and currently used for renal cryoablation treatments are often referred to simply as «kid» or «cryotherapy» and radiofrequency ablation, which is often called «radiofrequency ablation» to short. While surgeons currently use both technologies, it is increasingly clear to most experts in kidney cancer (kidney cancer) that cryoablation is safer and more effective. When the medical literature evaluates these two technologies is a half of the patients are less patients who fail treatment with radiofrequency cryotherapy
IN TABLE TITLE:
Table: Comparison of world literature
series between radiofrequency and cryoablation
Weld and Landman, British Journal of Urology 96 (9):. 1224, 2006
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Modality
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Number of patients
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Follow-up (months)
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Recurrence rate
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Complications
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| Radiofrequency |
277
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10
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7.9%
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13.9%
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Cryoablation
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326
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30.8
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4.6%
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10.6%
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Cryoablation uses ice to freeze the tumor. The ice created during this procedure differs from that seen in the ice outdoors on cold days or ice in our drinks cold. Ice normally get all of our coolers is 32 degrees Fahrenheit (0 degrees Celsius).Obviously we can make snowballs or take ice cubes, no damage to our hands this behavior of the ice is not harmful to living tissues with short-term exposure. In contrast, the ice created for cryoablation procedures is below 100 degrees Celsius and can destroy cancer tissue very efficiently. This ice can also be very accurately directed so that they can be used to destroy kidney cancer (kidney cancer) while normal kidney and normal structures that are near the kidneys preserved.
Figure A
Ice for cryoablation is created by inserting small probes (like needles) in the tumor. Figure A shows a cryoprobe real size.This probe is less than 1.5 mm in diameter and can destroy a large amount of cancer tissue. Clicking the probe will see a representation of the amount of kidney cancer (kidney cancer) (kidney cancer) that can eliminate this small probe. A single probe as shown in the figure or a group of several of these probes can be used to destroy kidney cancer (kidney cancer), while preserving the surrounding kidney.
Art:
Renal Cryoablation can be accomplished by any technique. Open surgery (large incisions to expose the kidney) is rarely used by surgeons experienced to procedures renal cryoablation, as far as open surgery is more painful, results in an increased bleeding and the recovery time is longer compared with less invasive techniques such as laparoscopy and percutaneous treatment.
By definition, open surgery is a minimally invasive technique, requiring large incisions to access and remove kidney cancer (kidney cancer). Open surgery refers to the original approach used by surgeons for which a scalpel is used to create a large incision. Today, some types of kidney cancer still require open surgery to achieve the best result.
Laparoscopic surgery techniques mimics open surgery (surgery performed with a large cut) but not a large incision is required. Instead, small incisions of about ½ inch (1 cm) in size are created. The soft body spaces are extended with inert gas and a small camera is created in the body. Small instruments can be used to treat disease without large incisions associated with open surgery. While it is not suitable for all kidney cancers, the vast majority of kidney cancers may be treated with a laparoscopic procedure performed by experienced surgeons.
Laparoscopic cryoablation is performed under general anesthesia and the procedure usually takes one to three hours.Three or four small incisions are made to properly expose the cancer so that the probes can be placed precisely in cancer.During placement of the probes and the removal of the cancer with the ice, the whole procedure can be precisely monitored using a device called a laparoscopic ultrasound probe. In experienced hands, this remarkable device that fits through the small laparoscopic incisions the surgeon can show you exactly where the kidney cancer (kidney cancer). In addition, the laparoscopic ultrasound probe is used to ensure that the entire tumor is destroyed by ice IBOLA created.During the procedure, a biopsy of kidney cancer (kidney cancer) is taken to determine the type of cancer that has been treated. Although the laparoscopic approach to cryoablation not involves making several small incisions, the technique allows the protection of the structures surrounding the kidney to ensure that complications are minimized. In addition, the laparoscopic approach allows more accurate and laparoscopic probes crioablation has the lowest rate of recurrence of any ablative technique guidance.
Another approach is minimally invasive percutaneous ablation. With the percutaneous access, no incisions. In fact, the surgeon works with a radiologist using imaging technology such as MRI, CT or ultrasound to deploy ablative probes radiographically kidney cancer (kidney cancer). The placement of the needles and the destruction of the tumor can be controlled with the use of images. The focus is usually performed under general anesthesia, but can be done under light anesthesia which is known as sedation. Percutaneous cryoablation is the least invasive procedure that can be done for kidney cancer (kidney cancer).
Candidates for renal cryoablation:
A significant number of patients with tumors and parameters that are critical in deciding the type of treatment that is best for a small renal mass. Considerations are many, but include: the size and general radiographic appearance of the mass, the anatomy of the mass, age and health of the patient, the general kidney function, the number of kidney damage, personal preferences of the patient, etc.
A cryoablation is a promising new approach for kidney cancer (kidney cancer). Several major medical centers have produced evidence that kidney cancer (kidney cancer) (kidney cancer) is cured in approximately 97% of patients who undergo laparoscopic cryoablation followed for three years. Five years of data demonstrating the successful treatment of kidney cancer (kidney cancer) (kidney cancer) in 93% of patients. However, a follow-up to 10 years in patients who have been treated by cryoablation is not yet available. As such, cryoablation is not usually performed in very young patients under normal circumstances. While there are no strict criteria of age, older patients with associated medical problems are generally considered good candidates for kidney cryoablation. The cryoablation procedure for a speedy recovery are typically associated with very little bleeding, fewer complications, and. As cryoablation patients usually tolerate well, people with renal masses and other associated medical conditions are generally good candidates for renal cryoablation.
In addition, patients with renal or only one kidney are also good candidates for renal cryoablation since the technique does not require the surgeon to control the blood supply to the kidney. Other techniques such as open and laparoscopic partial nephrectomy requires the surgeon to temporarily block the blood supply to the kidney which can have some negative effects on renal function.
Patients with hereditary diseases such as Von Hippel-Lindau disease often have multiple cases of kidney cancer in one or both kidneys. Occasionally, people who do not have this kind of hereditary disease may also have more kidney cancer in a kidney. As cryoablation only destroys cancer and leaves most of the intact kidney, there is a good approach for people with more than one renal cancer.
Advantages and disadvantages of renal cryoablation:
One advantage is that renal cryoablation can be performed by laparoscopy (with small incisions) or percutaneous (directly through the skin), which is a minimally invasive procedure for treating cancer kidney (kidney cancer). The minimally invasive nature of the procedure means that can be performed with minimal blood loss and without a large incision. After surgery, a minimally invasive approach results in less pain, shorter hospital stay and faster recovery compared with open surgery.
In general, the minimally invasive nature of cryoablation allows kidney cancer (kidney cancer) to be treated with minimal disruption in the life of patients. The return to routine activities of daily life is faster in minimally invasive techniques.Patients return to his family, work and routine activity in less than half the time it takes to recover from open surgery.
Also, in contrast to «the extirpative procedures» (procedures that cancer is cut open or laparoscopic partial nephrectomy or radical nephrectomy), patients undergoing ablation have a lower risk of some complications such as bleeding and leakage urine. However, the risk of bleeding is reduced by not having to cut into the kidney as is often done with laparoscopic or open surgery. Similarly, do not cut in the kidney minimizes the risk of damaging the leakage of urine «» collector kidney (the site in the kidney that carry urine), a complication known as system. «
Although cryoablation is a promising treatment for kidney cancer (kidney cancer), there are some limitations to this treatment. Cryoablation is not a good treatment for larger tumors. In fact, considering that in most case cryoablation not be considered for kidney cancers that are more than 4 cm (1 3/4 inches) in size. Moreover, the percutaneously (cryoablation through the skin) is only applicable to certain types of kidney cancer (kidney cancer), depending on the location in the kidney.
Because cryoablation is a new technique for treating kidney cancer (kidney cancer), there is no information available on the long-term results of the technique. Undoubtedly, this lack of information is a limitation of the technology. However, at present, several major centers have reported three-year and five-year follow-up data are very promising, with high cure rates.
The cryoablation procedure:
Laparoscopic cryoablation for kidney cancer (kidney cancer) is performed by a urologist (kidney surgeon) in an operating room. Prior to scheduling the procedure, each patient should have a broad consultation with your urologist about the nature of renal disease and all available treatments. This debate should review all the advantages and limitations of each treatment, surgical and nonsurgical approaches.
Once you and your urologist decided by the kidney cryoablation, choose a date for surgery. Typically, a patient goes to the hospital the day of surgery. General anesthesia (you are completely asleep) is mandatory. The procedure is performed through three or four small incisions that are or ½ inch or 1 cm in length (less than ¼ to ½ inch). The kidney is then identified so that kidney cancer (kidney cancer) (kidney cancer) can be found. Once the target is kidney cancer (kidney cancer) has been identified a biopsy is performed to determine the type of tissue being treated and one or more small tubes are placed in the kidney. Cryoablation probes are very small less than 1.5 mm in size (full size image in Figure A). An instrument known as laparoscopic ecografo is inserted through a small incision just to help cryoablation probes.
Once the probes have been placed precisely cryoablation, cryoablation device turns on and form balls «iceball» ice. Ice covers the surface of kidney cancer (kidney cancer) and a small area of normal tissue around the kidney cancer (kidney cancer) to ensure that no cancer cells remaining in the kidney. The laparoscopic ultrasound probe is used to confirm that the ice ball has eliminated all tissues of kidney cancer. Once the ice ball has grown and removed kidney cancer (kidney cancer), cryo-machine shuts down and the ball simply melts ice. The probes were removed from the kidneys. As the probes are very small, there is little risk of bleeding. The process is then complete.
Once the procedure is completed, each patient is taken to the recovery room for observation and then to a hospital ward.Usually the day after surgery, the patient can drink liquids, walk around and is relatively comfortable with limited pain.The day after surgery is common to have a regular diet. If all went well, most people are discharged the day after surgery with limited and controlled pain, eating a regular diet and feeling good. At high oral antibiotics and pain medications are prescribed.
Percutaneous cryoablation is performed in a room with CT or MRI by a urologist who works with an interventional radiologist. Prior to scheduling the procedure, each patient should have a broad consultation with your urologist about the nature of renal disease and all treatment options available. This debate should review all the advantages and limitations of each surgical approach and non-surgical. The patient comes to the day of surgery and the procedure is usually performed under general anesthesia. Under some conditions, the procedure can be performed under light anesthesia (also known as sedation).
The skin is marked and the location of the tumor in relation to the skin of reference is determined by CT or MRI scanner.After local anesthesia was administered, a needle is placed into the skin properly marking the tumor. Once the proper orientation is established, the biopsy is taken and cryoablation probes are placed on kidney cancer (kidney cancer).Ablation was performed as described in the laparoscopic procedure, and the patient was transferred to the recovery room. Typically, the patient is observed in the hospital overnight and then are discharged in the morning if all goes well.
Follow-up after cryoablation:
Biopsy results – The results of renal biopsy are returned from the lab about a week after surgery. Your surgeon will usually call home with these results.
Activity after surgery – While patients are usually able to make routine, such as feeding and caring for the needs of daily activities, usually suggest avoiding heavy lifting or strenuous activity, which will be held four to six weeks to allow the body to recover. While it is the responsibility of the surgeon, most surgeons suggest only lift small weights (less than 10 pounds), light activity and not driving one to two weeks after surgery. Typically, patients feel tired or lack energy for several weeks after surgery and full and complete return to normal activities take place four to six weeks. However, each patient is different and recovery is somewhat variable. Generally, the patient will feel better everyday.
Wound care and dressings – With laparoscopy wound care is generally very easy. Bandages (bands) are usually removed by the patient at home the second day after surgery. As part of the bands are small pieces of surgical tape. Once these begin to take off on their own, the patient may remove them. Removing the tape in the shower can be useful because the adhesive softens and allows the belt to be removed gently and painlessly. Below the belt are small wounds. The points are below the skin and do not have to be removed because it is absorbed by themselves.
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| Wound appearance on same day as laparoscopic kidney cancer surgery. |
Wound appearance 24 hours after laparoscopic kidney cancer surgery. |
Wound appearance two weeks after kidney cancer surgery. |
Bath – Swimming and bathing in a tub should not be done for a week after surgery, but the shower is generally permitted at any time after the second day after surgery. The shower should be regularly with soap and water. Efforts should be made to not allow the wounds to hit the shower directly in the early days. Wounds should be wiped dry with a clean towel and expose. A small amount of antiseptic is possible for the first few days after surgery, and a clean gauze with surgical tape may be used to keep clothing dry. However, if there is significant leakage from the wound or notice that the wound becomes red, warm or swollen, you should contact your doctor immediately.
Follow-up visit – Your doctor usually called with the results of the biopsy, a week after the surgery has been performed. A follow-up visit with the surgeon is usually scheduled about four weeks after the procedure has been done. In the follow-up visit is found that the wounds are well and radiographic images tracking is provided. Typically, an MRI or CT scan is scheduled for three months after the procedure has been carried out. Depending on the results of the biopsy and radiographic results of this evaluation, future monitoring will be established.
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