Preoperative Preparation

The preoperative preparation for renal cryoblation is the same as for open or laparoscopic approach.

Thorough history and physical examination is mandatory. A complete blood count, basic metabolic panel, urine analysis, and culture are routinely performed.

TABLE 1 ■ Laparoscopic Cryoablation Clinical Series

Intraoperative ultrasound should be performed to rule out multifocal lesions where multiple probes or an alternative treatment modality (i.e., open or laparoscopic radical nephrectomy) could be considered.

The preoperative preparation for renal cryoblation is the same as for open or laparoscopic approach.

TABLE 1 ■ Laparoscopic Cryoablation Clinical Series

No. of

Tumor size

OR time

Blood loss

Mean follow-up

Year

Author

tumors

(cm)

(min)

(cc)

(mo)

Recurrences

Complications

1998

Gill (10)

11

2.3

144

75

3

0

0

1999

Bishoff (16)

8

2

-

140

7.7

0

0

2000

Rodriguez (17)

3

2.2

234

111

14.2

0

0

2000

Gill (18)

34

2.3

174

66.8

16.2

0

0

2003

Lee(19)

20

2.6

305

92.5

14.2

1

1

2003

Colon (20)

8

2.6

120

102.5

-

0

0

2003

Nadler (21)

15

2.15

260

67

37

1

2

2003

Moon (22)

16

2.6

188

40

9.6

0

1

2004

Gill (23)

56

2.3

180

-

36

2

4

2004

Wisconsin

31

2.54

136

57

14.3

2

1

(unpublished

data)

Total

10

202

2.099

193.4

83.5

16.9

6

9

Abbreviation: OR, operating room.

Patients should be informed about the potential for performing a radical nephrectomy laparoscopic or open if the situation demands.

Metastatic evaluation usually includes a chest radiograph and abdominal computed tomography scan. A bone scan is reserved for patients with abnormal calcium and/or alkaline phosphatase levels. Magnetic resonance imaging is indicated in patients with contrast allergy or renal insufficiency. The majority of these patients may require preoperative clearance from an internist or a specialist for the comorbidities. Patients should sign an informed consent, which includes a detailed discussion about the limitations, expectations, and possible complications.

Patients should be informed about the potential for performing a radical nephrectomy laparoscopic or open if the situation demands.

We routinely perform bowel preparation with 300 mL of magnesium citrate with clear liquid diet a day prior to surgery and usually admit patients on the day of surgery. Patients are usually typed but not cross-matched for blood. Coordinating the procedure with an experienced radiologist in intraoperative laparoscopic ultrasound is often helpful.

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