Introduction: Percutaneous cryoablation is an emerging treatment option for the small renal mass. It poses a risk of thermal injury to adjacent tissues, limiting its application. We describe pneumodissection, a novel technique for preventing thermal injury during percutaneous cryoablation. Materials and Methods: The cases of 4 patients who underwent percutaneous renal cryoablation and pneumodissection were retrospectively reviewed. Results: Pneumodissection mechanically separated four tumors from overlying bowel segments (mean distance 1.2 ± 0.4 cm), permitting successful cryoablation. There were no complications or recurrences with 7.5 months of follow-up. Conclusions: Pneumodissection is a feasible displacement technique that facilitates percutaneous cryoablation in at-risk patients. Further study is warranted.

Keywords:
Renal mass, Cryosurgery, Pneumodissection
1.
Nguyen MM, Gill IS, Ellison LM: The evolving presentation of renal carcinoma in the United States: trends from the Surveillance, Epidemiology, and End Results program. J Urol 2006;176:2397-2400.
2.
Turna B, Kaouk JH, Frota R, Stein RJ, Kamoi K, Gill IS, et al: Minimally invasive nephron sparing management for renal tumors in solitary kidneys. J Urol 2009;182:2150-2157.
3.
Venkatesan AM, Wood BJ, Gervais DA: Percutaneous ablation in the kidney. Radiology 2011;261:375-391.
4.
Atwell TD, Callstrom MR, Farrell MA, Schmit GD, Woodrum DA, Leibovich BC, et al: Percutaneous renal cryoablation: local control at mean 26 months of followup. J Urol 2010;184:1291-1295.
5.
Uzzo RG, Novick AC: Nephron sparing surgery for renal tumors: indications, techniques and outcomes. J Urol 2001;166:6-18.
6.
Vricella GJ, Haaga JR, Adler BL, Dean N, Cherullo EE, Flick S, et al: Percutaneous cryoablation of renal masses: impact of patient selection and treatment parameters on outcomes. Urology 2011;77:649-654.
7.
Altunrende F, Autorino R, Hillyer S, Yang B, Laydner H, White MA, et al: Image guided percutaneous probe ablation for renal tumors in 65 solitary kidneys: functional and oncological outcomes. J Urol 2011;186:35-41.
8.
Tatli S, Acar M, Tuncali K, Morrison PR, Silverman S: Percutaneous cryoablation techniques and clinical applications. Diagn Interv Radiol 2010;16:90-95.
9.
Johnson DB, Solomon SB, Su LM, Matsumoto ED, Kavoussi LR, Nakada SY, et al: Defining the complications of cryoablation and radio frequency ablation of small renal tumors: a multi-institutional review. J Urol 2004;172:874-877.
10.
Ginat DT, Saad WE: Bowel displacement and protection techniques during percutaneous renal tumor thermal ablation. Tech Vasc Interv Radiol 2010;13:66-74.
11.
Haaga JR, Beale SM: Use of CO2 to move structures as an aid to percutaneous procedures. Radiology 1986;161:829-830.
12.
Menes T, Spivak H: Laparoscopy: searching for the proper insufflation gas. Surg Endosc 2000;14:1050-1056.
13.
Mirski MA, Lele AV, Fitzsimmons L, Toung TJ: Diagnosis and treatment of vascular air embolism. Anesthesiology 2007;106:164-177.
© 2013 S. Karger AG, Basel
2013
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