Comparison Of Postoperative Pain, Convalescence, And Patient Satisfaction Between Laparoscopic And Percutaneous Ablation Of Small Renal Masses

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology
Article Date: 24 Jul 2008 - 1:00 PDT

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UroToday.com - In this study of 58 laparoscopic cryoablations, 20 percutaneous cryoablations, and 15 percutaneous radiofrequency ablations for renal tumors averaging 2.2-2.6 cm., the percutaneous approaches resulted in statistically significant differences: shorter anesthesia time, shorter hospital stay, earlier return to no strenuous activity, and shorter time to full recovery.

The mean opioid use tended to be less in the percutaneous group, but this was not statistically significant. Of note, in all three groups, the average ASA was 3!

Complications were more common and more severe in the laparoscopic group; however, this was not statistically significant.

In 10-13% of the percutaneous patients, whether treated by cryoablation or by radiofrequency, a post-treatment neuropraxia developed (this accounted for 50% of the complications in both groups); this can now be avoided with use of a sheath to insulate the skin, nerves, and back muscles from the effects of the cryoprobe. It is clear to me that, for the majority of patients, image guided percutaneous treatment of renal masses 3 cm. and smaller is on its way to widespread acceptance.

All that is missing are two things: a.) 5 year follow-up (and some will want 10 years) and b.) interventional urologists skilled in image guided therapy. Both are coming..

Gaurav Bandi, Sean Hedican, Timothy Moon, Fred T. Lee, Stephen Y. Nakada.
J Endourol. May 1, 2008, 22(5): 963-968.
doi:10.1089/end.2007.0261

Reported by UroToday.com Medical Editor Ralph V. Clayman, MD

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