Alternative use of endocavitary probe to guide minimally invasive partial nephrectomy: is it reasonable?

Purpose: To describe the use of endocavitary ultrasound probe as an auxiliary tool when performing partial nephrectomy in cases of endophytic renal tumors, to standardize the method, and to report the preliminary results achieved with this technique. Methods: Fifteen patients diagnosed with completely endophytic underwent partial nephrectomy with the use of an endocavitary ultrasound probe. This article describes the technique involved in partial nephrectomy and details the preparation of the endocavitary ultrasound probe to ensure its safe use. Results: All the patients had a RENAL score between 8 and 11. The median time of warm ischemia was 26 and 18 minutes for laparoscopic or robot-assisted surgery, respectively. The median duration of surgery was 150 minutes, and the median console time was 145 minutes for the laparoscopic and robot-assisted surgery groups, respectively. The median estimate of blood loss was 200 mL. Only three patients in the laparoscopic group had focal positive surgical margins. There were no cases of infection at the site of probe entry. Conclusions: Intraoperative use of an endocavitary ultrasound probe for partial nephrectomy is possible and a safe alternative to the excision of endophytic tumors when neither robotic probes nor laparoscopic probes are available.

Crioablação: tratamento minimamente invasivo para tumores renais / Cryoablation: minimally invasive treatment for renal tumors

Atualmente, cerca de 60% dos tumores são diagnosticados por meio da ultra-sonografia ou da tomografia.As opções de tratamento padrão para os tumores renais menores do que 4 cm são a nefrectomia radical e parcial.Várias fontes de energia têm sido testadas de forma experimental para destruir tumores renais pequenos (criocirurgia, radiofreqüência, ultrasonografia de alta intensidade e outras) associadas a técnicas menos invasivas (percutânea ou laparoscópica).A cirurgia crioablativa oferece acesso minimamente invasivo no tratamento da maioria dos tumores renais pequenos (menores que 4 cm), minimizando o risco e morbidade da nefrectomia parcial aberta ou laparoscópica. A presença da ultra-sonografia no intra-operatório é essencial para o sucesso da crioablação.Alguns estudos com acompanhamento de três anos após crioablação de tumores renais demonstraram resultados com controle local da lesão de 85-95%.