ABSTRACT
Introduction/History 118
Principles of Cryosurgery 119
Pathophysiology of Cryosurgery 119
Contact vs. Puncture Cryoablation 119
Probe Size and Required Temperature for Successful Cryoablation 119
Heat Sink Phenomenon and the Need for Renal Artery Occlusion 120
Feasibility of Cryosurgery 121
Intraoperative Monitoring of Cryoablation 122
Number of Freeze Cycles 123
Surgical Margins and Pathologic Diagnosis 123
Clinical Studies 124
Patient Selection, Indications, and Suitability of Cryosurgery 126
Operative Technique 126
Risks and Benefits 129
Conclusions 130
References 130
With the advent of improved abdominal imaging over the last two decades, the
proportion of incidentally discovered renal cell carcinoma (RCC) has reached
nearly 50-60% (1-4). During the same time, interest in minimally invasive
alternatives for surgical ablation of renal neoplasms has also risen. Historically,
radical nephrectomy has been the standard for the treatment of RCC (5,6). Recent
studies, however, have demonstrated that nephron-sparing nephrectomy or
partial nephrectomies are also effective in the management of smaller RCCs
(,4 cm) (7-9). However, both are open procedures and require abdominal or flank incisions that can result in significant patient morbidity and a substantial
period of convalescence (10).
