Destruction of a portion of the kidney (renal tumor ablation) is often possible when a patient develops a tumor on their kidney. A common way to destroy a kidney tumor is by freezing it (cryoablation). These procedures can be performed laparoscopically, thereby lessening both the recovery and surgical risk.
Scott D. Miller, MD has some of the country’s most extensive private practice experience with laparoscopic kidney surgery. Having specialized in urologic laparoscopy since 1995, he was the first urologist in the state of Georgia to perform laparoscopic removal of the kidney for cancer in 1995. As a result, he has one of the largest series of long-term kidney cancer data following laparoscopic radical nephrectomy. Since that time he has applied these skills to even more complex laparoscopic kidney surgeries, including laparoscopic cryoablation of renal masses.
Laparoscopic cryoablation of the kidney involves freezing tissue under the guidance of both ultrasound and telescopic examination. Similar to other laparoscopic procedures, the surgeon makes a button-size incision for the insertion of a telescope. After expanding the body cavity with carbon dioxide gas, two or three additional small incisions are made to place narrow tubes used for interchangeable instruments. The surgeon can then visualize the kidney and the interchangeable instruments on a television monitor.
Once the abnormal area of the kidney is completely identified, a specialized ultrasound probe is placed through one of the narrow tubes and directly on the kidney. One or more freezing probes are then guided into the tumor. The freezing process can be simultaneously observed on the ultrasound and television monitors. A needle biopsy is often performed at the same time. The skin openings are closed with shower-resistant glue as a substitute for both stitches and bandages.
Results & More
Laparoscopic kidney cryoablation facilitates quicker recovery, less pain, and a lower complication rate as compared to the typical open-incision kidney surgery. Obviously, the primary goal is cancer cure. Our cure rates have either matched or surpassed any other published series for kidney cryoablation. A vast experience and a world-class surgical team help ensure this high level of success.
Most patients are discharged from the hospital the day following surgery. Risk of transfusion, damage to surrounding organs, blood clots, pneumonia, urine leakage from the kidney, and wound infection are each under 2%. When compared to partial removal of the kidney, ablation has a lower complication rate. However, since ablation does not have a long history, it is often reserved for patients greater than 60 years old or for patients with multiple kidney tumors.
Q: How do I keep my kidney(s) healthy? A: The kidneys are very vascular organs. For that reason, whatever is healthy for the body tends to be healthy for the kidney. The obvious recommendations are exercise, a balanced diet, and management of other medical conditions such as high cholesterol, hypertension, and diabetes. Of course, smoking is detrimental to both kidney and overall health. Although protein restriction is usually unnecessary, seek the advice of a physician prior to starting a high protein diet. A physician can also advise you of any medications to minimize or avoid.
Q: How much pain can I expect after the procedure? A: Pain is typically less with laparoscopic procedures when compared to open-incision surgery. Some abdominal cramps and shoulder discomfort can occur from the carbon dioxide gas used during surgery. This type of pain is best treated with anti-inflammatories rather than narcotics. Although everyone is different, post-operative discomfort is usually easily managed and short-lived.
Q: Is bruising normal after a laparoscopic procedure? A: When a narrow tube is placed through a button-size skin incision, a small blood vessel just below the skin can break. However, since the snug fit of this tube will compress the blood vessel during surgery, bleeding will often not occur. If this blood vessel were to re-open at a later time, a small amount of blood could track over a large surrounding area (including the genitalia). This is not a true bruise but will have the same appearance. Most important, this finding is not an indication of internal problems.
Q: When can I return to work or other normal activities following my surgical procedure? A: Dr. Scott Miller recommends at least two weeks away from work. Very few jobs would require more than four weeks of leave. In many cases, a small amount of light work-related duties are acceptable during the first two weeks. All patients should move around frequently from the time of surgery and resume light exercise at one week (gradually increasing to a normal routine by four weeks). Driving a car is often reasonable in approximately one week if reaction time is good. Of course, Dr. Scott Miller will provide guidance for each individual situation.
Q: How long does the surgery take Dr. Scott Miller to perform? A: Although many variables can affect the time necessary for Dr. Scott Miller to meticulously perform the surgery, he usually completes the procedure in two hours. However, the time away from family members also includes preparation (30-40 minutes), anesthetic reversal (15-20 minutes), and recovery room stay (2 or more hours). Dr. Scott Miller asks patients to arrive two hours prior to this process, during which time family members can remain present. Occasional updates are given to the family by the operating room nurse. Dr. Scott Miller will come to the waiting area when the patient is ready for transfer to the recovery room.
Q: How long do I stay in the hospital following surgery? A: Most patients are ready for discharge on the day following surgery.
Q: How does cancer cure with laparoscopic kidney cryoablation compare to complete kidney removal? A: Long term data is not yet available. However, short term results seem to be comparable. Since some questions are yet to be answered, this procedure is generally reserved for patients older than 60 years of age.
Q: Should I donate blood prior to my procedure? A: Since the risk of needing a blood transfusion is less than 1%, blood donation is not necessary.
Q: When can I shower or bathe following my surgery? A: Since shower-resistant glue was used as a substitute for both stitches and bandages, showering is acceptable once discharged from the hospital. Although water will not harm the surgical areas, mechanical cleansing of the incisions should be avoided for the first week to prevent premature removal of the glue. Complete immersion such as bathing or swimming is allowed at two weeks.
Q: What long-term follow-up care will I need? A: Initially MRI or CT scans are performed every few months.
Q: What other cancer treatments will I need after my surgery? A: If the disease persists in the kidney, it can be re-treated. Otherwise, no other treatments (such as radiation or chemotherapy) are routinely recommended unless disease is discovered outside of the kidney.
Q: Does tumor size influence whether I am a candidate for laparoscopic kidney cryoablation? A: Both tumor size and location influence whether a patient is a candidate for partial removal. Dr. Scott Miller will make his recommendation based on his review of the CT scan or MRI films.