Temperatures
may be plummeting outside, but they're nowhere
near as low as they are inside Huntington Hospital's
operating room, where urologist Christopher DiBlasio,
MD, is using cryoablation to treat kidney tumors,
essentially killing the cells by freezing and
thawing them repeatedly.
"Cryoablation is one
of the newer, cutting edge techniques to treat
kidney tumors," Dr. DiBlasio explained. The procedure
can be performed laparoscopically, which means
that rather than one large incision that exposes
the entire surgical field, the operation is performed
by inserting miniature video cameras and surgical
instruments into a series of tiny incisions.
The surgical
field is then projected onto high definition
monitors.
"Through these tiny
incisions we insert special cryoprobes and thermo
couplers to alternately freeze and thaw the tissue
and to monitor the temperature of the ice ball
to insure that we are reaching our goal of freezing
the targeted area" said Dr. DiBlasio.
Dr. DiBlasio uses intraoperative
laparoscopic ultrasound to isolate the tumor,
then inserts the freezing probes into the targeted
tissue. Real time ultrasound allows him to visualize
his progress as he manipulates the probes to freeze
and thaw the tumor for two or more cycles.
"Cryoablation is even
less invasive than laparoscopic partial nephrectomy,
which is where we remove only the tumor from a
kidney and salvage the remaining tissue in order
to maximize long-term kidney function," Dr. DiBlasio
said, describing another minimally invasive surgical
technique that has become the gold standard for
surgical removal of small kidney tumors.
When detected early,
kidney tumors are highly treatable with surgery.
However, with advanced age, any surgical procedure
is considered high risk. When 89-year-old Agnes
Chipman was diagnosed with a kidney tumor last
fall, her doctors initially had concerns about
recommending surgery. Fortunately, she was referred
to Dr. DiBlasio who was able to remove the tumor
using a laparoscopic procedure that significantly
reduced the risks associated with open surgery.
"It was the first surgery
I ever had," Mrs. Chipman recalled, describing
the small incision just below her navel. "Dr.
Chris is one super doctor. I had no pain. I can't
complain about the hospital, the doctors, the
nurses, or anything!"
Dr. DiBlasio stated,
"Mrs. Chipman, despite her age, was very active
in her recovery and this helps when we have motivated
patients who need surgery. Unfortunately for her,
she was not a candidate for a cryoablation procedure
due to the size and location of her kidney tumor.
Subsequently, we removed her entire kidney laparoscopically,
and she recovered quite briskly and has done very
well."
Laparoscopic surgery
offers a number of benefits for patients of every
age, not just the elderly. Advantages of minimally
invasive surgery include less post-operative pain
and need for pain medications, shorter recovery
times, decreased hospital stays, and a swifter
return to work and normal activities.
 "In
terms of cancer control, the outcomes of laparoscopic
surgery have been found to be equivalent to open
surgical approaches, though not all tumors are
amenable to laparoscopic removal," Dr. DiBlasio
said.
The duration of laparoscopic
surgery is typically shorter than an open procedure.
However, because it is technically more challenging,
two surgeons often work together. Dr. DiBlasio
has performed a number of laparoscopic kidney
procedures alongside attending urologist Alexander
Epelbaum, MD, general surgeon Robert Zingale,
MD, and his own father, attending urologist Fred
DiBlasio, Sr, MD.
Dr. DiBlasio noted
that the incidence of kidney cancer appears to
be increasing, primarily because of the availability
of sophisticated diagnostic imaging technology
such as ultrasound, CT scanning, and magnetic
resonance imaging (MRI). Because the disease tends
to be asymptomatic, many cases are detected coincidentally
during imaging studies ordered for other reasons.
When treated early, the cure rate for kidney cancer
can surpass the 90 percent range, according to
Dr. DiBlasio.
Because physicians
and patients alike prefer less invasive treatments,
cryoablation is finding a wider range of uses.
Dr. DiBlasio also uses this technique to treat
prostate cancer.
"Cryoablation in the
treatment of prostate cancer has provided equivalent
or superior oncologic outcomes when compared to
radiotherapy with the benefit of single day outpatient
surgery," he commented. Prostate cryoablation
is performed using transrectal ultrasound guidance
of cryoprobes and thermo couplers again to sculpt
an iceball that destroys the prostate gland and
cancer located within it.
"There is no incision
and therefore this is associated with minimal
if any blood loss," Dr. DiBlasio confirmed.
On the horizon, Dr.
DiBlasio is looking forward to launching a program
to perform renal cryoablation percutaneously (through
the skin) using CT guidance.
"If the tumor is located
in a certain part of the kidney, it can be easier
to access percutaneously with CT guided needle
and probe placement," he explained. "It doesn't
even require general anesthesia, so it is a great
option for patients that have small tumors and
may not be candidates for surgical removal due
to anesthesia risks." |
