Cryoablation of renal tumour

What is this?

This involves exposure of the kidney telescopically or through an incision in the side or simple placement of needles for freezing (probes) via punctures in the skin (percutaneous approach). The tumour(s) in the kidney is located, either within the abdominal cavity or externally, using ultrasound and then frozen using a special low temperature probe applied to the kidney. This may involve biopsy of the kidney at the time of surgery

What alternatives are there?

Observation, embolisation, partial nephrectomy, radical nephrectomy, laparoscopic or keyhole approaches to surgery

What to expect before procedure

You will usually be admitted on the same day as your surgery. You will normally receive an appointment for pre-assessment, approximately 14 days before your admission, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, House Officer and your named nurse. You will be asked not to eat or drink for 6 hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy. You will be given an injection under the skin of a drug (Clexane), that, along with the help of elasticated stockings provided by the ward, will help prevent thrombosis (clots) in the veins.

What happens during the procedure?

Normally, a full general anaesthetic will be used and you will be asleep throughout the procedure. In some patients, the anaesthetist may also use an epidural anaesthetic which improves or minimises pain post-operatively. You will usually be given an injectable antibiotic before the procedure after checking for any drug allergies. A catheter is inserted into the bladder at the start of the operation. The treatment is usually carried out using telescopes inserted into the abdomen or loin but may also be performed using an incision in the side (or loin). Several small puncture wounds are made to allow the telescopes and the freezing probes to be inserted. Occasionally, the treatment is carried out in the X-ray Department under CT control when the only punctures made are those for the freezing and temperature-monitoring probes. After insertion of the telescopes, the abnormal area is identified and samples are taken with a biopsy needle. The temperature and freezing probes are then inserted and two freezing cycles, each of 10 minutes, are performed. The treatment is monitored by ultrasound and by temperature probes. Once the probes have been removed, the bleeding is controlled with a special paste which promotes clot formation.

After the procedure

You will be encouraged to mobilise the next day and to take clear fluids by mouth immediately after the operation. The average hospital stay is 3 days.

Potential side effects