Raj K Goel1, Jihad H Kaouk. 1. Section of Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute Cleveland Clinic, Cleveland, OH 44195, USA.
Abstract
BACKGROUND: Cryoablation has been performed laparoscopically for small renal masses using 3-4 ports with promising oncologic results. OBJECTIVES: To report the initial experience of Single Port Access Renal Cryoablation (SPARC). DESIGN, SETTING, AND PARTICIPANTS: Beginning in September 2007, outcomes of patients undergoing SPARC have been recorded into an IRB approved database. Patients with localized small renal mass (<3 cm) ineligible for partial or radical nephrectomy were included. Patients with multiple abdominal surgeries or solitary kidneys were excluded. INTERVENTION: The novel multichannel single port was positioned in the umbilicus during the transperitoneal approach and at the tip of the 12th rib during the retroperitoneal approach. Intraoperative ultrasound was used to localize and observe the renal mass during cryoablation. MEASUREMENT: Operative time, blood loss, hospital stay, and complications were noted. Tumor characteristics and follow-up CT scans were evaluated. RESULTS AND LIMITATIONS: All six cases, four retroperitoneal and two transperitoneal, underwent SPARC without conversion to laparoscopy or open surgery. Patient age and body mass index was 73+/-9 yr and 33+/-10 kg/m2, respectively. Mean tumor size was 2.6+/-0.4 cm. Total freeze time was 15+/-1.8 min. There were no intraoperative complications and mean hospital stay was 2.3 d. One patient had a prolonged hospital stay due to preexisting respiratory condition. CT with contrast was performed in three patients and documented no residual tumor enhancement. Although flexible laparoscopic instruments allow parallel insertion through a single port, surgical range of motion is limited and clashing of instruments is frequent. CONCLUSION: Single Port Access Renal Cryoablation (SPARC) for small renal masses is feasible and safe. Transperitoneal approach provides a virtually scarless surgery since the surgical incision is hidden in the umbilicus. Further studies are needed to define the role of and evaluate the potential advantages of single port surgery.
BACKGROUND: Cryoablation has been performed laparoscopically for small renal masses using 3-4 ports with promising oncologic results. OBJECTIVES: To report the initial experience of Single Port Access Renal Cryoablation (SPARC). DESIGN, SETTING, AND PARTICIPANTS: Beginning in September 2007, outcomes of patients undergoing SPARC have been recorded into an IRB approved database. Patients with localized small renal mass (<3 cm) ineligible for partial or radical nephrectomy were included. Patients with multiple abdominal surgeries or solitary kidneys were excluded. INTERVENTION: The novel multichannel single port was positioned in the umbilicus during the transperitoneal approach and at the tip of the 12th rib during the retroperitoneal approach. Intraoperative ultrasound was used to localize and observe the renal mass during cryoablation. MEASUREMENT: Operative time, blood loss, hospital stay, and complications were noted. Tumor characteristics and follow-up CT scans were evaluated. RESULTS AND LIMITATIONS: All six cases, four retroperitoneal and two transperitoneal, underwent SPARC without conversion to laparoscopy or open surgery. Patient age and body mass index was 73+/-9 yr and 33+/-10 kg/m2, respectively. Mean tumor size was 2.6+/-0.4 cm. Total freeze time was 15+/-1.8 min. There were no intraoperative complications and mean hospital stay was 2.3 d. One patient had a prolonged hospital stay due to preexisting respiratory condition. CT with contrast was performed in three patients and documented no residual tumor enhancement. Although flexible laparoscopic instruments allow parallel insertion through a single port, surgical range of motion is limited and clashing of instruments is frequent. CONCLUSION: Single Port Access Renal Cryoablation (SPARC) for small renal masses is feasible and safe. Transperitoneal approach provides a virtually scarless surgery since the surgical incision is hidden in the umbilicus. Further studies are needed to define the role of and evaluate the potential advantages of single port surgery.
Authors: Kamran Ahmed; Tim T Wang; Vanash M Patel; Kamal Nagpal; James Clark; Mariam Ali; Samer Deeba; Hutan Ashrafian; Ara Darzi; Thanos Athanasiou; Paraskevas Paraskeva Journal: Surg Endosc Date: 2010-07-10 Impact factor: 4.584
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