50593 Ablation, renal tumor(s), unilateral, percutaneous, cryotherapy

Name of the Procedure:

Ablation, renal tumor(s), unilateral, percutaneous, cryotherapy

Summary

Ablation via cryotherapy for renal tumors involves using extreme cold to destroy cancer cells in the kidney. This minimally invasive procedure is performed using imaging guidance to precisely target and freeze the tumor tissue without the need for a large incision.

Purpose

The procedure targets renal tumors, specifically in one kidney, to arrest the growth of malignant cells. The expected outcome is the eradication of the tumor with minimal impact on surrounding healthy tissue, preserving as much kidney function as possible.

Indications

This procedure is indicated for patients with:

• Small renal tumors, typically less than 4 cm in diameter.
• A need for a minimally invasive treatment due to other health complications preventing major surgery.
• Tumors in patients with only one functional kidney or impaired renal function.
• Recurrent renal tumors after previous treatments.

Preparation

• Patients may be instructed to fast for several hours before the procedure.
• Blood tests, imaging studies (e.g., CT scans or MRIs), and a thorough medical evaluation are conducted beforehand.
• Medication adjustments, including the temporary cessation of blood thinners, may be necessary.

Procedure Description

1. Under local anesthesia and sedation, or sometimes general anesthesia, the patient is positioned appropriately.
2. Using imaging guidance (CT or ultrasound), a thin needle-like cryoprobe is inserted through the skin and advanced to the tumor site.
3. The cryoprobe delivers liquid nitrogen or argon gas, creating an ice ball to freeze and destroy the tumor cells.
4. The tissue is allowed to thaw, and the freeze-thaw cycle may be repeated to ensure complete ablation.
5. The cryoprobe is removed, and a small bandage is applied to the insertion site.

Duration

The procedure typically takes 1 to 3 hours, depending on the size and number of tumors treated.

Setting

The procedure is usually performed in a hospital or an outpatient surgical center equipped with imaging facilities.

Personnel

• Interventional radiologist or urologist performs the procedure.
• Assisting nurses and technicians.
• Anesthesiologist or nurse anesthetist if general anesthesia is used.

Risks and Complications

Common risks include:

• Bleeding or hematoma.
• Infection at the insertion site.
• Injury to surrounding tissues or organs.

Rare complications:

• Injury to renal function.
• Frostbite to tissues outside the targeted area. These are typically managed with close monitoring and supportive care.

Benefits

• Minimally invasive with smaller incisions and quicker recovery.
• Effective in achieving tumor control with minimal damage to surrounding tissue.
• Preservation of kidney function.

Recovery

• Patients may be observed for several hours post-procedure or overnight.
• Resume normal activities within a few days, but heavy lifting and strenuous activities should be avoided for a week.
• Follow-up imaging studies to assess the ablation success and monitor for recurrence.

Alternatives

• Surgical resection (partial or total nephrectomy).
• Radiofrequency ablation or microwave ablation.
• Active surveillance in selected cases.
• Pros: Superior in certain large or complex tumors.
• Cons: More invasive, longer recovery time, higher risk of complications.

Patient Experience

• Mild discomfort at the insertion site.
• Pain management includes prescribed analgesics as needed.
• Post-procedural care includes hydration, avoiding strenuous activities, and attending follow-up appointments for imaging and evaluation.