Cryotherapy is a form of thermal therapy for the treatment of small renal masses, particularly in high-risk patients. However, optimal application and the critical temperature for in vivo cell death have not been well established. Additionally, most centers do not currently monitor temperature during the procedure. Using in vitro gel, ex vivo porcine kidney, and in vivo porcine kidney models, we have demonstrated with both of the commercially available cryotherapy units that tissue temperatures are variable and that gel, while providing reproducible isotherms, is not an accurate model for temperature planning in vivo, likely because of the heat sink effect of highly vascular renal tissue. Placing the cryoprobes through and slightly beyond the tumor and using multi-point temperature sensing probes is recommended to improve the accuracy of the procedure.
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References
1.
PantuckAJ, ZismanA, BelldegrumAS. The changing natural history of renal cell carcinoma. J Urol, 2001; 166:1611–1623.
2.
ChowWH, DevesaSS, WarrenJLet al.Rising incidence of renal cell cancer in the United States. JAMA, 1999; 281:1628–1631.
3.
VolpeA, PanzarellaT, RendonRAet al.The natural history of incidentally detected small renal masses. Cancer, 2004; 100:738–745.
4.
NisbetAA, RiederJM, TranVQet al.Decision tree of laparoscopic partial nephrectomy versus laparoscopic renal cryoablation for small renal masses. J Endourol, 2009; 23:431–437.
5.
KunkleD, EglestonB, UzzoR. Excise, ablate or observe: The small renal mass dilemma—a meta-analysis and review. J Urol, 2008; 179:1227–1234.
WoolleyML, SchulsingerDA, DurandDBet al.Effect of freezing parameters (freeze cycle and thaw process) on tissue destruction following renal cryoablation. J Endourol, 2002; 16:519–522.
8.
ChosySG, NakadaSY, LeeFTet al.Monitoring renal cryosurgery: Predictors of tissue necrosis in swine. J Urol, 1998; 159:1370–1374.
9.
BishoffJT, ChenRB, LeeBRet al.Laparoscopic renal cryoablation: Acute and long-term clinical, radiographic, and pathologic effects in an animal model and application in a clinical trial. J Endourol, 1999; 13:233–239.
10.
BredaA, LamJS, RiggsSet al.In vivo efficacy of laparoscopic assisted percutaneous renal cryotherapy: Evidence based guidelines for the practicing urologist. J Urol, 2008; 179:333–337.
11.
SandisonGA, LoyeMP, RewcastleJCet al.X-ray CT monitoring of iceball growth and thermal distribution during cryosurgery. Phys Med Biol, 1998; 43:3309–3324.
12.
PermpongkosolS, LinkRE, KavoussiLRet al.Temperature measurements of the low-attenuation radiographic ice ball during CT-guided renal cryoablation. Cardiovasc Intervent Radiol, 2008; 31:116–121.
13.
CaviezelA, TerrazS, SchmidlinFet al.Percutaneous cryoablation of small kidney tumours under magnetic resonance imaging guidance: Medium-term follow-up. Scand J Urol Nephrol, 2008; 45:412–416.
14.
AugeBK, Santa-CruzRW, PolascikTJ. Effect of freeze time during renal cryoablation: A swine model. J Endourol, 2006; 20:1101–1105.
GageAA, BaustJ. Mechanisms of tissue injury in cryosurgery. Cryobiology, 1998; 37:171–186.
17.
SchmidlinFR, RuppCC, HoffmannNEet al.Measurement and prediction of thermal behavior and acute assessment of injury in a pig model of renal cryosurgery. J Endourol, 2001; 15:193–197.
18.
GilbertJC, RubinskyB, WongSTet al.Temperature determination in the frozen region during cryosurgery of rabbit liver using MR image analysis. Magn Reson Imaging, 1997; 15:657–667.
19.
LaddAP, RescorlaFJ, BaustJGet al.Cryosurgical effects on growing vessels. Am Surg, 1999; 65:677–682.
20.
SteeleG. Cryoablation in hepatic surgery. Semin Liver Dis, 1994; 14:120–125.
21.
RivoireML, VoighoEJ, KaemmerlenPet al.Hepatic cryosurgery precision: Evaluation of ultrasonography, thermometry, and impedancemetry in a pig model. J Surg Oncol, 1996; 61:242–248.
22.
WeberSM, LeeFT, ChinnDOet al.Perivascular and intralesional tissue necrosis after hepatic cryoablation: Results in a porcine model. Surgery, 1997; 122:742–747.
23.
MagalovZ, ShitzerA, DeganiD. Isothermal volume contours generated in a freezing gel by embedded cryo-needles with applications to cryo-surgery. Cryobiology, 2007; 55:127–137.
24.
BeemsterP, LagerveldBW, de la RosetteJJet al.The performance of 17-gauge cryoprobes in vitro. Technol Cancer Res Treat, 2008; 7:321–328.
25.
YoungJL, KollaSB, PickDLet al.In vitro, ex vivo and in vivo isotherms for renal cryotherapy. J Urol, 2010; 183:752–758.
26.
HegartyNJ, KaoukJH, RemerEMet al.Laparoscopic renal cryoablation: Oncologic outcomes at 5 years. J Endourol, 2006; 20:A12(abstract).
27.
DavolPE, FulmerBR, RukstalisDB. Long-them results of cryoablation for renal cancer and complex renal masses. Urology, 2006; 68:2–6.
