Comparison of renal ablation with cryotherapy, dry radiofrequency, and saline augmented radiofrequency in a porcine model

Comparison of renal ablation with cryotherapy, dry radiofrequency, and saline augmented radiofrequency in a porcine model

Author Collyer, W. C. Google Scholar
Landman, J. Google Scholar
Olweny, E. O. Google Scholar
Andreoni, C. Google Scholar
Kerbl, K. Google Scholar
Bostwick, D. G. Google Scholar
Clayman, R. V. Google Scholar
Institution Washington Univ
Universidade Federal de São Paulo (UNIFESP)
Abstract BACKGROUND: Needle ablative therapy has recently generated a lot of interest in the urologic community We compare renal lesions produced in a porcine model using three forms of needle ablative energy: cryoablation (CR), dry radiofrequency (RF), and saline augmented radiofrequency (SARF).STUDY DESIGN: in 10 farm pigs, under ultrasonographic guidance, 40 laparoscopic renal lesions were produced: 825-mm CR lesions were produced with 2.4-mm cryoprobes (Endocare Inc, Irvine, CA), after 1-mL preinfusions of 14.6% saline, 12 SARF lesions were created with 22-gauge needles (2 mL/minute 14.6% saline, 50W 510 kHz RF for 60 seconds), 12 RF lesions were created with a 2-cm array LeVeen electrode and an RF2000 generator using impedance limited 30 to 60 W double activations (Radiotherapeutics Corp, Mountain View, CA), and 8 RF lesions were produced using 22-gauge needles and double 10 W activations with the RF2000 generator. Eight animals were sacrificed after I week for acute pathology. An additional two animals were sacrificed at 8 weeks to provide chronic pathology results for the LeVeen dry RF and SARF modalities.RESULTS: CR produced a regular 18- to 22-mm zone of complete necrosis bordered by a 1.5- to 2.5-mm zone of partial necrosis. Acutely, LeVeen RF and single-needle RF produced lesions 25 to 45 mm and 6 to 10 mm wide, respectively. Acutely, SARF produced irregular cone-shaped lesions 15 to 31 mm wide. Only one of eight acute LeVeen RF lesions showed complete necrosis; none of the four 8-week LeVeen RF lesions displayed complete necrosis. Two of the four 8-week SARF lesions displayed complete necrosis. the remainder of the LeVeen RF, single-needle RF, and SARF lesions showed early, indeterminate tubular damage with relative glomerular sparing and bands of complete necrosis (0.5 to 1.5 mm) and inflammation (0.5 to 2 mm) at the periphery. Only CR could be consistently monitored with laparoscopic ultrasonography.CONCLUSIONS: Renal cryoablation produces well-defined, completely necrotic lesions that can be monitored reliably with ultrasonography. Longer followup may be required to characterize the full extent of renal necrosis produced by RF, but in the short run, none of the RF modalities reliably produced 100% necrosis in all cases. (J Am Coll Surg 2001;193:505-513. (C) 2001 by the American College of Surgeons).
Language English
Date 2001-11-01
Published in Journal of the American College of Surgeons. New York: Elsevier B.V., v. 193, n. 5, p. 505-513, 2001.
ISSN 1072-7515 (Sherpa/Romeo, impact factor)
Publisher Elsevier B.V.
Extent 505-513
Access rights Closed access
Type Article
Web of Science ID WOS:000171953300006

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