Retroperitoneal laparoendoscopic single-site (LESS) renal cryoablation: The first clinical series in China / 第二军医大学学报

ABSTRACT

Objective To summarize our experience on the first clinical series of retroperitoneal laparoendoscopic single-site(LESS) renal cryoablation in mainland China and to assess its safety and feasibility after obtaining the informed consents. Methods Two patients with small renal masses underwent retroperitoneal laparoendoscopic single-site renal cryoablation by the same urologic surgical team at March 14, 2012 and March 19, 2012 in our department. The male patient was 79 years old, with the Charlson comorbidity index (CCI, Age-weighted) being 4, maximal tumor diameter being 2. 7 cm, R. E. N. A. L. score being 2 + 2 + 3 + p+3 = 10p,and preoperation eGFR being 61. 5 ml/(min • 1. 73 m2). The female patient was 43 years old with CCI (Age-weighted) being 3, maximal tumor diameter being 2. 6 cm, R. E. N. A. L. score being 1 + 1 + 1 + a+2 = 5a, and preoperation eGFR being 187. 8 ml/(min • 1. 73 m2). At the level of midaxillary line, we made a 2-cm longitudinal skin incision at the mid-point between the iliac crest and the inferior margin of 12th rib. The renal masses were fully isolated and exposed, and then two 2-mm cryoprobes were percutaneously introduced and placed into the tumor under laparoscopic visualization. Two freeze-thaw cryoablation cycles were performed according to the instruction of EndoCare Cryo-Care Surgery System. Results The two procedures were smoothly completed without any extra skin incision. The operative duration, cyroablation time, estimated blood loss, and postoperative hospital stay of the male and female patients were 185/170 min, 30/30 min, 50 /30 ml, 6/5 d, respectively; and the postoperative pain scores measured by the visual analogscale (VAS) were 2/1, 1/1, and 0/0 at day 1, day 2, and day 3, respectively. Pathologic examination revealed clear cell renal cell carcinoma in both patients (Fuhrman gradeH and I). The eGFR at 1-month after operation was 60. 2/144. 3 ml/(min • 1. 73 m2) in both patients. CT scan found no evidence of recurrence at the cyroablative region 1 week and 1 month after operation. Conclusion Our initial experience shows that laparoendoscopic single-site renal cryoablation is a safe, feasible and effective procedure, with small incision, less pain, less damage of renal function, rapid recovery, and satisfactory short-term effect, but the patients should be carefully chosen. And the long-term effect should be confirmed by large sample study.