Crioterapia renal laparoscópica: experiencia inicial

objective: renal cryotherapy has been described as a minimally invasive procedure that represents an alternative for selected patients with small renal tumors. our preliminary experience with this procedure is reported. material y methods: eighteen patients with 21 tumors with a mean tumor size of 2.2 cm (1-4) in the preoperative ct scan underwent renal cryotherapy using a double freeze-thaw cycle. the group consisted of 14 males (64%) and 4 females (18% with a mean age of 68 years (32-84). all patients had undergone prior surgery for renal tumor in the treated or the opposite kidney. a transperitoneal laparoscopic approach was used in all patients. results: mean operating time was 196 minutes (120-140), and no patient received transfusions during or after surgery. no complications occurred in 14 patients (64%). perirenal abscess, splenic laceration, ureteral lesion, and polar artery lesion occurred in one patient each. peroperative biopsy was performed in 5 patients (22.7%) and was positive for renal cancer in two cases, while material was insufficient in three patients. mean hospital stay was 6 days (2-16). creatinine levels were 106 mg% (48-230) before surgery and 123 mg/% (52-270) 6 months after surgery. a ct scan was performed in all patients one and six months after surgery, showing a residual enhancement area in two of them. sixteen patients (88.8%) are disease-free after a mean follow-up time of 46 months (6-116). metastatic disease occurred in two patients (11%) in the setting of a prior renal tumor in the same or the opposite kidney and required treatmet with antiangiogenic agents. conclusions: this is the largest series reporting renal cryosurgery in spain, in complex cases and with adequate follow-up. results are encouraging and allow for considering renal cryotherapy among the minimally invasive procedures for nephron-sparing surgery.