March 1, 2007

Percutaneous Computerized Tomography Guided Renal Cryoablation Using Local Anesthesia: Pain Assessment As the technique of laparoscopic and open cryoablation of renal tumors has been popularized, an increasing number of investigators have continued to raise the bar attempting similar ablations using a percutaneous technique.

In the September issue of the Journal of Urology, Permpongkosol, Kavoussi and colleagues from Johns Hopkins and North Shore-Long Island Jewish Health System report their experience with 25 patients with 30 renal tumors treated with cryoablation using only local anesthesia.

The mean patient age was 67 years (range 33 to 80) with a mean tumor size of 2.1 cm. Mean ice ball size was 4.1 cm. A mean of 44 cc of 1% lidocaine was injected in the skin, subcutaneous tissue, muscle and renal capsule along the tracts where the cryotherapy probes would be placed. Ablations were performed in the prone position using CT guidance with an average treatment time of 68 minutes. Pain scores were assessed during and after the procedure (scale 0 to 1).

Pain scores were zero before and after the procedure in all patients. Mean pain score after the first freeze was 1.8. Successful completion of ablation with local anesthesia only was completed in 85% of patients. Mean time to recovery was 112 minutes. Five complications occurred, including contrast allergy, transhepatic probe insertion with hematoma, perinephric hematoma with pleural effusion (2 units transfused), and 2 patients with transient nausea.

While these data suggest that percutaneous renal cryoablation using only local anesthesia is feasible, the question remains, what is the down-side of administering intravenous sedation in this setting, since it may be given with minimal morbidity with the added amnestic effects. Perhaps if a patient with a 2.1 cm mass has too many co morbidities to undergo conscious sedation, his renal mass should undergo active surveillance.

PermpongkosolВ S, SulmanВ A, SolomonВ SB, GongВ GX, KavoussiВ LR
J Urol 176(3): 915-918, 2006.

Reviewed by Contributing Editor Ricardo SГЎnchez-Ortiz, MD

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