Laparoscopic Cryo Okay For Selected Cases

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Treating renal masses with either laparoscopic cryoablation (LCA) or laparoscopic partial nephrectomy (LPN) achieves similar clinical outcomes, a study found.

Although LCA is associated with lower mean estimated blood loss, shorter operative time, and a lower risk of converting to open surgery, researchers believe that in experienced hands, “LPN is a preferred option for most elderly patients and should be considered when contemplating definitive treatment of renal masses,” researchers wrote in BJU International (2006;99:395-398).

The investigators explained that LPN has advantages overs LCA. “LPN allows accurate diagnosis and staging of renal malignancies and avoids the sampling error associated with biopsy,” they observed. In addition, follow-up of ablated lesions is rigorous and less cost-effective because the lesions remain in the kidney.

Samir S. Taneja, MD, and his colleagues at New York University School of Medicine compared 15 pa-tients who underwent LCA for renal masses with matched cohort of 15 patients who underwent LPN. Mean operative times were 248.4 minutes for LPN and 152.2 minutes for LCA. Mean estimated blood loss was 221.7 mL in LPN group and 58.7 mL in the LCA group. Two patients in the LPN group (13%), but none of the LCA-treated patients, required conversion to open surgery.

The two groups were similar with respect to hospital length of stay (4.4 and 3.3 days for the LPN and LCA patients, respectively) and postoperative creatinine levels (1.18 and 1.19 mg/dL, respectively) and hematocrit (34.6% and 35.1%, respectively). Although still experimental, LCA is a good choice for elderly patients with comorbidities precluding blood loss or renal ischemia, the researchers concluded.

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