Hand-assisted Laparoscopic Partial Nephrectomy: Laparoscopic partial nephrectomy is appropriate for certain patients with small renal tumors (generally less than 4 centimeters). The tumor is excised and the remainder of the kidney is repaired. In the past, this procedure was done as an open surgery (requiring a large, eight to 10 inch incision and five to seven days of hospital stay). Now, thanks to advances in endoscopic technology and instrumentation, the hand-assisted laparoscopic procedure involves a much smaller (2-1/2 inch) incision along with two tiny incisions for the camera and instrument ports. Post-operative hospital stay is 5 days or less. Patients benefit from faster healing, less pain, and less scarring than patients undergoing open partial nephrectomy. Since 2004, Dr. Chris Teigland has been doing hand-assisted laparoscopic partial nephrectomies with Dr. Kent Kercher, general surgeon and Chief of Clinical Activities for the Center for Laparoscopic and Advanced Surgical Procedures.

Their combined experience has resulted in excellent outcomes for their patients and no tumor recurrences to date.

Cryotherapy: Cryotherapy (also called cryoablation or cryosurgery) is an established technique for treating skin, liver and other tumors. Recently, it has successfully been used to destroy certain small kidney tumors. At Carolinas Medical Center, our specialized team of physicians employs CT (computerized tomography) imaging to position a long, thin "cryoprobe" into the tumor. When the cryoprobe is turned on, an "ice ball" forms, destroying the tumor while leaving the surrounding healthy tissue intact. This freeze/thaw process may be repeated several times to ensure that the tumor is completely destroyed. Cryoablation may be done laparoscopically (in the operating room under general anesthesia) or percutaneously (under local anesthesia), depending on the patient's unique situation. Most percutaneous cryotherapy patients are able to go home the next day, reporting minimal pain, less complications and a more rapid recovery than open surgical patients¹.

Radiofrequency Ablation: Percutaneous radiofrequency ablation (RFA) uses high-energy radio waves to destroy small tumors within the kidney. For certain patients, percutaneous RFA is an ideal alternative to surgery because it can effectively and safely destroy small kidney tumors without the risks of undergoing a major operation. At Carolinas Medical Center, our specialized team of physicians use CT and ultrasound guidance to locate the tumor. A long, needle-like probe is connected with an electrical energy source to selectively destroy tumor tissue using high-energy radio waves. Most patients undergoing RFA go home the next day, and they report minimal post-operative pain and a low incidence of complications. Thus far, tumor recurrence is extremely rare (long-term data is still being collected)².

Expectant Management: Some small renal (kidney) tumors are best managed by a watchful waiting approach. Patients with these tumors may not be at significant risk for developing renal cell carcinoma, but instead should continue to undergo periodic imaging studies and physician follow-up appointments to track changes in renal function and kidney tumor size. Dr. Teigland and the multidisciplinary team at Carolinas Medical Center are happy to work with each patient in order to determine the most effective imaging and follow-up protocol for these small renal tumors.

References

1. Novick, A.C. Cleveland Clinic Foundation. VHL Family Forum 8:1, March 2000.
2. Matsumoto E, Johnson B, Ogan K, et al. Short term efficacy of temperature based radiofrequency ablation of small renal tumors. Urology; 65: 877-881.