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Jihad H Kaouk - One of the best experts on this subject based on the ideXlab platform.
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laparoscopic Cryoablation for renal cell carcinoma 100 month oncologic outcomes
The Journal of Urology, 2015Co-Authors: Peter A Caputo, Erick M Remer, Charles M Omalley, Daniel Ramirez, Homayoun Zargar, Oktay Akca, Hiury S Andrade, Jihad H KaoukAbstract:Purpose: With the incidence of renal cell carcinoma on the rise treatment options for the small renal mass have broadened. Cryoablation is increasingly used as a therapeutic option for renal tumors in select cases. However, studies with long-term oncologic outcomes are sparse. We evaluated the long-term oncologic outcomes of laparoscopic renal mass Cryoablation.Materials and Methods: We reviewed our laparoscopic Cryoablation database for patients treated with laparoscopic Cryoablation from October 1997 to February 2005. Patients with less than 3 months of followup were excluded from study. Patient and tumor characteristics, and perioperative outcomes, including complications, were recorded. Recurrence-free, cancer specific and overall survival was analyzed using Kaplan-Meier curves.Results: A total of 142 tumors in 138 consecutive patients were treated with laparoscopic Cryoablation. Mean age of the cohort was 66.35 years. Of the patients 99 (71.7%) were male and 39 (28.3%) were female. Mean body mass ind...
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probe ablative nephron sparing surgery Cryoablation versus radiofrequency ablation
Urology, 2006Co-Authors: Nicholas J Hegarty, Inderbir S Gill, Mihir M Desai, Erick M Remer, Charles M Omalley, Jihad H KaoukAbstract:Over the past decade, a number of probe ablative therapies have emerged for the treatment of patients with localized renal tumors. Cryoablation and radiofrequency ablation (RFA) have been studied in the greatest detail. We present the results of 164 laparoscopic Cryoablations and 82 percutaneous RFAs performed in our institution and compare them retrospectively in terms of complications, impact on renal function, follow-up imaging, and oncologic outcomes. Comparison of cryotherapy versus RFA revealed that mean tumor size was similar (2.56 cm vs 2.51 cm); however, the Cryoablation group had a greater number of anteriorly located tumors (39% vs 10%), as well as fewer central tumors (6% vs 37%) and fewer solitary kidneys (24% vs 49%). Mean thermal treatment time was 19.3 minutes versus 32.2 minutes in the Cryoablation and RFA groups, respectively. Radiologic evidence of tumor recurrence or persistence of disease was noted in 3 patients (1.8%) who underwent Cryoablation and in 9 (11.1%) who were treated with RFA. All of have been successfully treated with repeat ablation/nephrectomy, or they are currently under observation. Complication rates were minimal in both groups; no significant impact on mean serum creatinine levels was noted. Cancer-specific survival following cryotherapy was 98% at a median follow-up of 3 years and 100% for RFA at 1-year median follow-up. Cryoablation and RFA are developmental nephron-sparing options. Early results are encouraging for both forms of probe ablation in terms of early oncologic control, preservation of renal function, and low complication rates. Longer-term oncologic data are necessary so that the true value of these treatment modalities can be determined.
Ralph V. Clayman - One of the best experts on this subject based on the ideXlab platform.
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percutaneous and laparoscopic Cryoablation of small renal masses
The Journal of Urology, 2008Co-Authors: David S. Finley, Shawn M. Beck, Geoffrey N. Box, William Chu, Leslie A. Deane, Duane Vajgrt, Elspeth M. Mcdougall, Ralph V. ClaymanAbstract:Purpose: We reviewed our 4-year experience with percutaneous Cryoablation and laparoscopy for treating small renal masses.Materials and Methods: After institutional review board approval we retrospectively analyzed renal Cryoablation procedures performed between March 2003 and October 2007. An in-depth analysis was performed concerning demographics, hospital course and short-term outcome with respect to percutaneous vs laparoscopic Cryoablation.Results: A total of 37 patients underwent treatment for 43 renal masses. Of the 37 patients 19 underwent laparoscopic Cryoablation (24 tumors) and 18 underwent percutaneous Cryoablation (19 tumors) using computerized tomography fluoroscopy. For percutaneous Cryoablation a saline instillation was used in 58% of cases to move nonrenal vital structures away from the targeted renal mass. There were 5 cases of hemorrhage requiring transfusion, all of which were associated with the use of multiple cryoprobes. The transfusion rate in the percutaneous and laparoscopic cryo...
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Percutaneous and laparoscopic Cryoablation of small renal masses.
The Journal of urology, 2008Co-Authors: David S. Finley, Shawn M. Beck, Geoffrey N. Box, William Chu, Leslie A. Deane, Duane Vajgrt, Elspeth M. Mcdougall, Ralph V. ClaymanAbstract:We reviewed our 4-year experience with percutaneous Cryoablation and laparoscopy for treating small renal masses. After institutional review board approval we retrospectively analyzed renal Cryoablation procedures performed between March 2003 and October 2007. An in-depth analysis was performed concerning demographics, hospital course and short-term outcome with respect to percutaneous vs laparoscopic Cryoablation. A total of 37 patients underwent treatment for 43 renal masses. Of the 37 patients 19 underwent laparoscopic Cryoablation (24 tumors) and 18 underwent percutaneous Cryoablation (19 tumors) using computerized tomography fluoroscopy. For percutaneous Cryoablation a saline instillation was used in 58% of cases to move nonrenal vital structures away from the targeted renal mass. There were 5 cases of hemorrhage requiring transfusion, all of which were associated with the use of multiple cryoprobes. The transfusion rate in the percutaneous and laparoscopic Cryoablation groups was 11.1% and 27.8%, respectively. Operative time was significantly longer in the laparoscopic Cryoablation group compared to the percutaneous Cryoablation group at 147 (range 89 to 209) vs 250.2 (range 151 to 360) minutes, respectively. The overall complication rate (including transfusion) was lower in the percutaneous Cryoablation group compared to the laparoscopic Cryoablation group (4 of 18 [22.2%] vs 8 of 20 [40%], respectively). Hospital stay was significantly shorter in the percutaneous vs laparoscopic Cryoablation group at 1.3 vs 3.1 days, p <0.0001, respectively. Narcotic use in the percutaneous Cryoablation group was more than half that used by the laparoscopic Cryoablation group (5.1 vs 17.8 mg, p = 0.03, respectively). Among patients with biopsy proven renal cell carcinoma during a median followup of 11.4 and 13.4 months in the percutaneous and laparoscopic Cryoablation groups, cancer specific survival was 100% and 100%, respectively, and the treatment failure rate was 5.3% and 4.2%, respectively. Percutaneous Cryoablation is an efficient, minimally morbid method for the treatment of small renal masses and it appears to be superior to the laparoscopic approach. Short-term followup has shown no difference in tumor recurrence or need for re-treatment. Of note, hemorrhage was solely associated with the use of multiple probes.
Stephen B Solomon - One of the best experts on this subject based on the ideXlab platform.
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Development of a Searchable Database of Cryoablation Simulations for Use in Treatment Planning
Cardiovascular and interventional radiology, 2017Co-Authors: F. Edward Boas, Govindarajan Srimathveeravalli, Jeremy C. Durack, Elena Kaye, Joseph P. Erinjeri, Etay Ziv, Majid Maybody, Hooman Yarmohammadi, Stephen B SolomonAbstract:To create and validate a planning tool for multiple-probe Cryoablation, using simulations of ice ball size and shape for various ablation probe configurations, ablation times, and types of tissue ablated. Ice ball size and shape was simulated using the Pennes bioheat equation. Five thousand six hundred and seventy different Cryoablation procedures were simulated, using 1-6 Cryoablation probes and 1-2 cm spacing between probes. The resulting ice ball was measured along three perpendicular axes and recorded in a database. Simulated ice ball sizes were compared to gel experiments (26 measurements) and clinical Cryoablation cases (42 measurements). The clinical Cryoablation measurements were obtained from a HIPAA-compliant retrospective review of kidney and liver Cryoablation procedures between January 2015 and February 2016. Finally, we created a web-based Cryoablation planning tool, which uses the Cryoablation simulation database to look up the probe spacing and ablation time that produces the desired ice ball shape and dimensions. Average absolute error between the simulated and experimentally measured ice balls was 1 mm in gel experiments and 4 mm in clinical Cryoablation cases. The simulations accurately predicted the degree of synergy in multiple-probe ablations. The Cryoablation simulation database covers a wide range of ice ball sizes and shapes up to 9.8 cm. Cryoablation simulations accurately predict the ice ball size in multiple-probe ablations. The Cryoablation database can be used to plan ablation procedures: given the desired ice ball size and shape, it will find the number and type of probes, probe configuration and spacing, and ablation time required.
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Image-guided percutaneous Cryoablation of renal tumors.
Techniques in vascular and interventional radiology, 2007Co-Authors: Majid Maybody, Stephen B SolomonAbstract:With the advent of new diagnostic modalities and improvement in techniques, more renal tumors are diagnosed at earlier stages. Partial nephrectomy for small renal tumors has been shown to be effective for treatment and for preservation of renal function; however, this approach also has morbidity and mortality risks. It has been more than 30 years since operative Cryoablation was first used in urology, and the tissue-destructive properties of Cryoablation are well established. Cryoablation used for tumor destruction has the potential for maximum preservation of renal parenchyma. With the advent of smaller cryoprobes, the possibility of performing percutaneous image-guided Cryoablation has become a reality. The technique appears safe. Its efficacy can only be assumed based on the literature of operative Cryoablation; however, it affords a possible approach for patients who cannot undergo surgery.
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computerized tomography guided percutaneous renal Cryoablation with the patient under conscious sedation initial clinical experience
The Journal of Urology, 2006Co-Authors: Ajay Gupta, Mohamad E Allaf, Louis R Kavoussi, Thomas W Jarrett, David Y S Chan, Stephen B SolomonAbstract:Purpose: We report on our initial clinical experience with CT guided percutaneous renal Cryoablation.Materials and Methods: CT guided percutaneous renal Cryoablation was performed on 27 tumors using conscious sedation in 20 patients. Eligible patients had tumors of 5 cm or less and were poor surgical candidates or otherwise warranted nephron sparing treatment. Tumors were classified as central or noncentral depending on their relationship to the renal sinus fat. During Cryoablation intraoperative active ice ball formation was monitored with real-time CT imaging to ensure adequate tumor coverage. Postoperative followup imaging was obtained at regular intervals.Results: Our method appears technically feasible as of the 27 Cryoablations performed, only 1 complication occurred requiring blood transfusion in a patient with a large, centrally located tumor. To date we have 16 tumors in 12 patients with imaging followup of 1 month or more (mean followup 5.9 months). Mean baseline tumor size in this group was 2.5...
Erick M Remer - One of the best experts on this subject based on the ideXlab platform.
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laparoscopic Cryoablation for renal cell carcinoma 100 month oncologic outcomes
The Journal of Urology, 2015Co-Authors: Peter A Caputo, Erick M Remer, Charles M Omalley, Daniel Ramirez, Homayoun Zargar, Oktay Akca, Hiury S Andrade, Jihad H KaoukAbstract:Purpose: With the incidence of renal cell carcinoma on the rise treatment options for the small renal mass have broadened. Cryoablation is increasingly used as a therapeutic option for renal tumors in select cases. However, studies with long-term oncologic outcomes are sparse. We evaluated the long-term oncologic outcomes of laparoscopic renal mass Cryoablation.Materials and Methods: We reviewed our laparoscopic Cryoablation database for patients treated with laparoscopic Cryoablation from October 1997 to February 2005. Patients with less than 3 months of followup were excluded from study. Patient and tumor characteristics, and perioperative outcomes, including complications, were recorded. Recurrence-free, cancer specific and overall survival was analyzed using Kaplan-Meier curves.Results: A total of 142 tumors in 138 consecutive patients were treated with laparoscopic Cryoablation. Mean age of the cohort was 66.35 years. Of the patients 99 (71.7%) were male and 39 (28.3%) were female. Mean body mass ind...
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percutaneous Cryoablation of renal tumors patient selection technique and postprocedural imaging
Radiographics, 2010Co-Authors: Brian C Allen, Erick M RemerAbstract:Percutaneous Cryoablation of renal tumors requires a number of important steps for success and relies heavily on imaging for treatment planning, intraprocedural guidance and monitoring, detection of untreated tumor, and surveillance for disease progression. Imaging-guided percutaneous Cryoablation has several advantages over laparoscopic Cryoablation. In particular, computed tomography (CT) and magnetic resonance (MR) imaging allow global evaluation of the ablation zone and an accurate depiction of the treatment margin. Ultrasonography allows real-time guidance of probe placement but cannot help depict ice ball formation as accurately as CT or MR imaging. Multiphasic CT or MR imaging should be performed at structured intervals following ablation. Treated tumors are expected to decrease in size over time, and lesion growth and internal or nodular enhancement are suspicious for tumor recurrence or progression. Complications include probe site pain, hematoma, incomplete ablation, and recurrent tumor. Current limitations of percutaneous Cryoablation include the inability to control hemorrhage without intraarterial access and a lack of long-term follow-up data. Nevertheless, percutaneous Cryoablation is an effective choice for minimally invasive nephron-sparing treatment of renal tumors.
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probe ablative nephron sparing surgery Cryoablation versus radiofrequency ablation
Urology, 2006Co-Authors: Nicholas J Hegarty, Inderbir S Gill, Mihir M Desai, Erick M Remer, Charles M Omalley, Jihad H KaoukAbstract:Over the past decade, a number of probe ablative therapies have emerged for the treatment of patients with localized renal tumors. Cryoablation and radiofrequency ablation (RFA) have been studied in the greatest detail. We present the results of 164 laparoscopic Cryoablations and 82 percutaneous RFAs performed in our institution and compare them retrospectively in terms of complications, impact on renal function, follow-up imaging, and oncologic outcomes. Comparison of cryotherapy versus RFA revealed that mean tumor size was similar (2.56 cm vs 2.51 cm); however, the Cryoablation group had a greater number of anteriorly located tumors (39% vs 10%), as well as fewer central tumors (6% vs 37%) and fewer solitary kidneys (24% vs 49%). Mean thermal treatment time was 19.3 minutes versus 32.2 minutes in the Cryoablation and RFA groups, respectively. Radiologic evidence of tumor recurrence or persistence of disease was noted in 3 patients (1.8%) who underwent Cryoablation and in 9 (11.1%) who were treated with RFA. All of have been successfully treated with repeat ablation/nephrectomy, or they are currently under observation. Complication rates were minimal in both groups; no significant impact on mean serum creatinine levels was noted. Cancer-specific survival following cryotherapy was 98% at a median follow-up of 3 years and 100% for RFA at 1-year median follow-up. Cryoablation and RFA are developmental nephron-sparing options. Early results are encouraging for both forms of probe ablation in terms of early oncologic control, preservation of renal function, and low complication rates. Longer-term oncologic data are necessary so that the true value of these treatment modalities can be determined.
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Laparoscopic renal Cryoablation: initial clinical series
Urology, 1998Co-Authors: Inderbir S Gill, Erick M Remer, Andrew C. Novick, Jon J Soble, Gyung Tak Sung, Jonathan Hale, Charles M. O'malleyAbstract:Abstract Objectives. To present the technique and short-term results of retroperitoneal laparoscopic renal Cryoablation. Methods. Ten patients underwent laparoscopic renal Cryoablation of 11 exophytic renal tumors ranging in size from 1.5 to 3 cm identified on computed tomography. Tumors were located at the upper (3), middle (5), or lower (3) pole of the kidney. Three patients had a solitary kidney. A 3-port retroperitoneal laparoscopic approach was used to create renal cryolesions. Puncture Cryoablation was performed with a 4.8-mm cryoprobe. Real-time, endoscopic, steerable, color Doppler ultrasound was used to monitor the evolving cryolesion. All patients have completed a minimum follow-up of 3 months (mean 5.5, range 3 to 9). Results. Cryoablation was technically successful in all 10 patients (11 tumors). Under ultrasound guidance, the ice ball was intentionally created up to 1 cm beyond the tumor edge with the aim of achieving negative margins. Mean surgical time was 2.4 hours, Cryoablation (double freeze-thaw) time 12.9 minutes, cryoprobe tip temperature −186°C, and blood loss 75 mL. Systemic temperature remained unaltered. Hospital stay was less than 23 hours in 9 of 10 patients. Follow-up magnetic resonance imaging at 1 day and 1, 2, and 3 months identified the punched-out, nonenhancing, spontaneously resorbing, renal cryolesion. Follow-up biopsies of the cryoablated tumor site were negative for cancer in the 3 patients who have undergone the biopsy. Conclusions. The initial series of laparoscopic renal Cryoablation is presented. The retroperitoneoscopic approach, by avoiding the peritoneal cavity, minimizes the chances of the bowel coming in contact with the evolving cryolesion, and the potential sequelae thereof. Laparoscopic renal Cryoablation is currently developmental and long-term data are awaited. Nevertheless, it is potentially an attractive addition to available nephron-sparing surgical techniques.
George F Van Hare - One of the best experts on this subject based on the ideXlab platform.
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Cryoablation of accessory pathways in the coronary sinus in young patients: a multicenter study from the Pediatric and Congenital Electrophysiology Society's Working Group on Cryoablation
Journal of cardiovascular electrophysiology, 2007Co-Authors: Kathryn K Collins, Anne M Dubin, Edward K. Rhee, Joel A. Kirsh, Bryan C. Cannon, Frank A. Fish, George F Van HareAbstract:This is a multicenter retrospective study evaluating the immediate- and mid-term outcomes of Cryoablation of accessory pathways in the coronary sinus in children or in patients with congenital heart disease. Twenty-one patients (median age 13.0 years, range 2-40) from six institutions were included. The accessory pathways were concealed in 11 and manifest in 10. Of 12 patients who had coronary sinus angiography, two had large coronary sinus diverticula, one had a dilated coronary sinus due to a left superior vena cava to coronary sinus, and one had a "pouch" at the mouth of the coronary sinus. Six patients underwent ablation procedures with Cryoablation alone, while in the remaining 15 patients, both Cryoablation and radiofrequency ablation were utilized. The ablation procedure included left-sided endocardial mapping via a retrograde or transseptal approach in 13 (62%). Procedural success was achieved with Cryoablation in the coronary sinus in 15/21 (71%). Four patients (19%) had successful radiofrequency ablation at the right or left posterior septum. Two patients (10%) had unsuccessful procedures. Of the 15 patients with initially successful Cryoablation procedures, six (40%) had arrhythmia recurrences at a median of 17 days (range 1-120). Recurrences could not be explained by differences in patient or procedural variables. Cryoablation in the coronary venous system in young patients is feasible but associated with a high arrhythmia recurrence rate. Cryoablation techniques and/or equipment need to be improved in order to safely create more permanent lesions in this arrhythmia substrate.
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Cryoablation versus radiofrequency ablation for treatment of pediatric atrioventricular nodal reentrant tachycardia initial experience with 4 mm cryocatheter
Heart Rhythm, 2006Co-Authors: Kathryn K Collins, Anne M Dubin, Nancy A Chiesa, Kishor Avasarala, George F Van HareAbstract:Background Initial reports have shown Cryoablation to be safe and efficacious for treatment of atrioventricular nodal reentrant tachycardia (AVNRT). No direct comparisons of Cryoablation vs radiofrequency (RF) catheter ablation in pediatric patients have been made. Objectives The purpose of this study was to compare the outcomes of cryothermal vs RF catheter ablation for treatment of AVNRT in pediatric patients. Methods We retrospectively reviewed consecutive ablation procedures for treatment of AVNRT at a single arrhythmia center. The RF group consisted of patients who underwent RF ablation from 2002 until cryothermy became available. The Cryoablation group consisted of patients who underwent cryothermal ablation from 2004 to 2005. The groups were compared for procedural and electrophysiologic outcomes. Results RF (n = 60, age 14 ± 4 years) and Cryoablation (n = 57, age 14 ± 4 years) groups had similar demographic and baseline parameters. Procedural times were shorter in the RF group (RF ablation 112 ± 31 minutes vs Cryoablation 148 ± 46 minutes, P P = .77). In an intention-to-treat analysis, success of the procedure was 100% for RF ablation and 95% for Cryoablation ( P = .11). No permanent AV block occurred in either group. Recurrence rates were higher for the Cryoablation group, but this did not reach statistical significance (RF ablation 2% vs Cryoablation 8%, P = .19). Conclusion Cryoablation appears to be similar to RF for ablation of AVNRT with respect to short-term efficacy and safety of the procedure in a pediatric population. Recurrence rates are higher with Cryoablation.