Today I performed a cryoablation of a left sided renal mass determined pre-operatively to be about 3.2cm and mesophytic. Upon dissection, however, we discovered it was exophytic and measured just under 4cm. The dissection and ablation went smoothly, but during the first thaw cycle I noticed some cracking of the tumor. I gently applied some Floseal and added pressure with Surgicel. After the second thaw, we watched the tumor for over 20 mintues and there was no bleeding.
I think this case offers two lessons. First, tumors over 3.5cm (particularly those that are exophytic) are really not great candidates for laparoscopic cryoablation. Daniel Lehman recently reviewed our Columbia database and reached the same conclusion. Second, if you do attempt to cryoablate a larger mass, it’s important to dissect out the artery early on so you can get hilar control if needed, and to have the operating team prepare Floseal and Surgicel in advance.
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