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Kidney Ablation
Mitchell Tublin, MD; Ashraf Thabet, MD; Zachary B. Jenner, MD
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KEY FACTS

  • Preprocedure

    • Procedure

      • Post Procedure

        TERMINOLOGY

        • Definitions

          • Ablation: Image-guided induction of thermal/nonthermal apoptosis
            • Performed either laparoscopically or percutaneously
            • Thermal ablation
              • Radiofrequency ablation (RFA): Electric current to produce heat
                • Most common modality used for renal ablation
              • Cryoablation: Freezing/thawing cycle
                • Also frequently used modality for renal ablation
                • Larger ablation zone and less procedural pain when compared to RFA
                • Joule-Thomson effect
              • Microwave ablation: Water molecule agitation to produce heat
                • Offers faster ablation times; less susceptibility to thermal heat-sink effect
              • High-intensity focused US: Coagulative necrosis caused by high-intensity US beam focused on small tissue volume
                • Respiratory motion/overlying ribs problematic
            • Nonthermal ablation
              • Irreversible electroporation: Electrical disruption of cell membrane integrity
                • Promising preliminary animal/human data
                • Frequently used for perivascular lesions or lesions adjacent to renal collecting system (not susceptible to heat-sink)
              • Chemical ablation (ethanol)
                • Inconsistent cellular necrosis in renal tumors
                • Not routinely used for renal ablation
          • Thermal heat-sink effect
            • Thermal energy needed to achieve cytotoxicity is dissipated
            • Convective heat transfer to adjacent structures
              • Blood flow in vessels abutting tumor prevents adequate heat generation for effective ablation

        PREPROCEDURE

        • Indications

          • Contraindications

            • Preprocedure Imaging

              • Getting Started

                PROCEDURE

                • Patient Position/Location

                  • Equipment Preparation

                    • Procedure Steps

                      • Alternative Procedures/Therapies

                        POST PROCEDURE

                        • Expected Outcome

                          • Things to Avoid

                            • Postprocedure Imaging

                              OUTCOMES

                              • Complications

                                Selected References

                                1. Aarts BM et al: Percutaneous microwave ablation of histologically proven T1 renal cell carcinoma. Cardiovasc Intervent Radiol. 43(7):1025-33, 2020
                                2. Thompson SM et al: Introduction of microwave ablation into a renal ablation practice: valuable lessons learned. AJR Am J Roentgenol. 211(6):1381-9, 2018
                                3. Okhunov Z et al: Comparison of outcomes in patients undergoing percutaneous renal cryoablation with sedation vs general anesthesia. Urology. 85(1):130-4, 2015
                                4. Thompson RH et al: Comparison of partial nephrectomy and percutaneous ablation for cT1 renal masses. Eur Urol. 67(2):252-9, 2015
                                5. Woldu SL et al: Comparison of renal parenchymal volume preservation between partial nephrectomy, cryoablation, and radiofrequency ablation. J Endourol. 29(8):948-55, 2015
                                6. Floridi C et al: Microwave ablation of renal tumors: state of the art and development trends. Radiol Med. 119(7):533-40, 2014
                                7. Gunn AJ et al: Percutaneous ablation of the small renal mass-techniques and outcomes. Semin Intervent Radiol. 31(1):33-41, 2014
                                8. Hinshaw JL et al: Percutaneous tumor ablation tools: microwave, radiofrequency, or cryoablation--what should you use and why? Radiographics. 34(5):1344-62, 2014
                                9. Wagstaff P et al: Thermal ablation in renal cell carcinoma management: a comprehensive review. Curr Opin Urol. 24(5):474-82, 2014
                                10. Atwell TD et al: Percutaneous ablation of renal masses measuring 3.0 cm and smaller: comparative local control and complications after radiofrequency ablation and cryoablation. AJR Am J Roentgenol. 200(2):461-6, 2013
                                11. Kaufman JA et al: Vascular and Interventional Radiology: The Requisites. 2nd ed. Elsevier, 2013
                                12. El Dib R et al: Cryoablation vs radiofrequency ablation for the treatment of renal cell carcinoma: a meta-analysis of case series studies. BJU Int. 110(4):510-6, 2012
                                13. Whitson JM et al: Population-based comparative effectiveness of nephron-sparing surgery vs ablation for small renal masses. BJU Int. 110(10):1438-43; discussion 1443, 2012
                                14. Rosenberg MD et al: Percutaneous cryoablation of renal lesions with radiographic ice ball involvement of the renal sinus: analysis of hemorrhagic and collecting system complications. AJR Am J Roentgenol. 196(4):935-9, 2011
                                15. Venkatesan AM et al: Percutaneous ablation in the kidney. Radiology. 261(2):375-91, 2011
                                16. Breen DJ et al: Minimally invasive treatment of small renal tumors: trends in renal cancer diagnosis and management. Cardiovasc Intervent Radiol. 33(5):896-908, 2010
                                17. Thumar AB et al: Thermal ablation of renal cell carcinoma: triage, treatment, and follow-up. J Vasc Interv Radiol. 21(8 Suppl):S233-41, 2010
                                18. Arellano RS et al: Percutaneous CT-guided radiofrequency ablation of renal cell carcinoma: efficacy of organ displacement by injection of 5% dextrose in water into the retroperitoneum. AJR Am J Roentgenol. 193(6):1686-90, 2009
                                19. Gervais DA et al: Percutaneous image-guided therapy of intra-abdominal malignancy: imaging evaluation of treatment response. Abdom Imaging. 34(5):593-609, 2009
                                20. Uppot RN et al: Imaging-guided percutaneous ablation of renal cell carcinoma: a primer of how we do it. AJR Am J Roentgenol. 192(6):1558-70, 2009
                                21. Cantwell CP et al: Protecting the ureter during radiofrequency ablation of renal cell cancer: a pilot study of retrograde pyeloperfusion with cooled dextrose 5% in water. J Vasc Interv Radiol. 19(7):1034-40, 2008
                                22. Hui GC et al: Comparison of percutaneous and surgical approaches to renal tumor ablation: metaanalysis of effectiveness and complication rates. J Vasc Interv Radiol. 19(9):1311-20, 2008
                                23. Kunkle DA et al: Excise, ablate or observe: the small renal mass dilemma--a meta-analysis and review. J Urol. 179(4):1227-33; discussion 1233-4, 2008
                                24. Kunkle DA et al: Cryoablation or radiofrequency ablation of the small renal mass : a meta-analysis. Cancer. 113(10):2671-80, 2008
                                25. Lokken RP et al: Inflammatory nodules mimic applicator track seeding after percutaneous ablation of renal tumors. AJR Am J Roentgenol. 189(4):845-8, 2007
                                26. Warlick CA et al: Clinical sequelae of radiographic iceball involvement of collecting system during computed tomography-guided percutaneous renal tumor cryoablation. Urology. 67(5):918-22, 2006
                                27. Gervais DA et al: Radiofrequency ablation of renal cell carcinoma: part 1, Indications, results, and role in patient management over a 6-year period and ablation of 100 tumors. AJR Am J Roentgenol. 185(1):64-71, 2005
                                28. Gervais DA et al: Radiofrequency ablation of renal cell carcinoma: part 2, Lessons learned with ablation of 100 tumors. AJR Am J Roentgenol. 185(1):72-80, 2005
                                Related Anatomy
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                                Related Differential Diagnoses
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                                References
                                Tables

                                Tables

                                KEY FACTS

                                • Preprocedure

                                  • Procedure

                                    • Post Procedure

                                      TERMINOLOGY

                                      • Definitions

                                        • Ablation: Image-guided induction of thermal/nonthermal apoptosis
                                          • Performed either laparoscopically or percutaneously
                                          • Thermal ablation
                                            • Radiofrequency ablation (RFA): Electric current to produce heat
                                              • Most common modality used for renal ablation
                                            • Cryoablation: Freezing/thawing cycle
                                              • Also frequently used modality for renal ablation
                                              • Larger ablation zone and less procedural pain when compared to RFA
                                              • Joule-Thomson effect
                                            • Microwave ablation: Water molecule agitation to produce heat
                                              • Offers faster ablation times; less susceptibility to thermal heat-sink effect
                                            • High-intensity focused US: Coagulative necrosis caused by high-intensity US beam focused on small tissue volume
                                              • Respiratory motion/overlying ribs problematic
                                          • Nonthermal ablation
                                            • Irreversible electroporation: Electrical disruption of cell membrane integrity
                                              • Promising preliminary animal/human data
                                              • Frequently used for perivascular lesions or lesions adjacent to renal collecting system (not susceptible to heat-sink)
                                            • Chemical ablation (ethanol)
                                              • Inconsistent cellular necrosis in renal tumors
                                              • Not routinely used for renal ablation
                                        • Thermal heat-sink effect
                                          • Thermal energy needed to achieve cytotoxicity is dissipated
                                          • Convective heat transfer to adjacent structures
                                            • Blood flow in vessels abutting tumor prevents adequate heat generation for effective ablation

                                      PREPROCEDURE

                                      • Indications

                                        • Contraindications

                                          • Preprocedure Imaging

                                            • Getting Started

                                              PROCEDURE

                                              • Patient Position/Location

                                                • Equipment Preparation

                                                  • Procedure Steps

                                                    • Alternative Procedures/Therapies

                                                      POST PROCEDURE

                                                      • Expected Outcome

                                                        • Things to Avoid

                                                          • Postprocedure Imaging

                                                            OUTCOMES

                                                            • Complications

                                                              Selected References

                                                              1. Aarts BM et al: Percutaneous microwave ablation of histologically proven T1 renal cell carcinoma. Cardiovasc Intervent Radiol. 43(7):1025-33, 2020
                                                              2. Thompson SM et al: Introduction of microwave ablation into a renal ablation practice: valuable lessons learned. AJR Am J Roentgenol. 211(6):1381-9, 2018
                                                              3. Okhunov Z et al: Comparison of outcomes in patients undergoing percutaneous renal cryoablation with sedation vs general anesthesia. Urology. 85(1):130-4, 2015
                                                              4. Thompson RH et al: Comparison of partial nephrectomy and percutaneous ablation for cT1 renal masses. Eur Urol. 67(2):252-9, 2015
                                                              5. Woldu SL et al: Comparison of renal parenchymal volume preservation between partial nephrectomy, cryoablation, and radiofrequency ablation. J Endourol. 29(8):948-55, 2015
                                                              6. Floridi C et al: Microwave ablation of renal tumors: state of the art and development trends. Radiol Med. 119(7):533-40, 2014
                                                              7. Gunn AJ et al: Percutaneous ablation of the small renal mass-techniques and outcomes. Semin Intervent Radiol. 31(1):33-41, 2014
                                                              8. Hinshaw JL et al: Percutaneous tumor ablation tools: microwave, radiofrequency, or cryoablation--what should you use and why? Radiographics. 34(5):1344-62, 2014
                                                              9. Wagstaff P et al: Thermal ablation in renal cell carcinoma management: a comprehensive review. Curr Opin Urol. 24(5):474-82, 2014
                                                              10. Atwell TD et al: Percutaneous ablation of renal masses measuring 3.0 cm and smaller: comparative local control and complications after radiofrequency ablation and cryoablation. AJR Am J Roentgenol. 200(2):461-6, 2013
                                                              11. Kaufman JA et al: Vascular and Interventional Radiology: The Requisites. 2nd ed. Elsevier, 2013
                                                              12. El Dib R et al: Cryoablation vs radiofrequency ablation for the treatment of renal cell carcinoma: a meta-analysis of case series studies. BJU Int. 110(4):510-6, 2012
                                                              13. Whitson JM et al: Population-based comparative effectiveness of nephron-sparing surgery vs ablation for small renal masses. BJU Int. 110(10):1438-43; discussion 1443, 2012
                                                              14. Rosenberg MD et al: Percutaneous cryoablation of renal lesions with radiographic ice ball involvement of the renal sinus: analysis of hemorrhagic and collecting system complications. AJR Am J Roentgenol. 196(4):935-9, 2011
                                                              15. Venkatesan AM et al: Percutaneous ablation in the kidney. Radiology. 261(2):375-91, 2011
                                                              16. Breen DJ et al: Minimally invasive treatment of small renal tumors: trends in renal cancer diagnosis and management. Cardiovasc Intervent Radiol. 33(5):896-908, 2010
                                                              17. Thumar AB et al: Thermal ablation of renal cell carcinoma: triage, treatment, and follow-up. J Vasc Interv Radiol. 21(8 Suppl):S233-41, 2010
                                                              18. Arellano RS et al: Percutaneous CT-guided radiofrequency ablation of renal cell carcinoma: efficacy of organ displacement by injection of 5% dextrose in water into the retroperitoneum. AJR Am J Roentgenol. 193(6):1686-90, 2009
                                                              19. Gervais DA et al: Percutaneous image-guided therapy of intra-abdominal malignancy: imaging evaluation of treatment response. Abdom Imaging. 34(5):593-609, 2009
                                                              20. Uppot RN et al: Imaging-guided percutaneous ablation of renal cell carcinoma: a primer of how we do it. AJR Am J Roentgenol. 192(6):1558-70, 2009
                                                              21. Cantwell CP et al: Protecting the ureter during radiofrequency ablation of renal cell cancer: a pilot study of retrograde pyeloperfusion with cooled dextrose 5% in water. J Vasc Interv Radiol. 19(7):1034-40, 2008
                                                              22. Hui GC et al: Comparison of percutaneous and surgical approaches to renal tumor ablation: metaanalysis of effectiveness and complication rates. J Vasc Interv Radiol. 19(9):1311-20, 2008
                                                              23. Kunkle DA et al: Excise, ablate or observe: the small renal mass dilemma--a meta-analysis and review. J Urol. 179(4):1227-33; discussion 1233-4, 2008
                                                              24. Kunkle DA et al: Cryoablation or radiofrequency ablation of the small renal mass : a meta-analysis. Cancer. 113(10):2671-80, 2008
                                                              25. Lokken RP et al: Inflammatory nodules mimic applicator track seeding after percutaneous ablation of renal tumors. AJR Am J Roentgenol. 189(4):845-8, 2007
                                                              26. Warlick CA et al: Clinical sequelae of radiographic iceball involvement of collecting system during computed tomography-guided percutaneous renal tumor cryoablation. Urology. 67(5):918-22, 2006
                                                              27. Gervais DA et al: Radiofrequency ablation of renal cell carcinoma: part 1, Indications, results, and role in patient management over a 6-year period and ablation of 100 tumors. AJR Am J Roentgenol. 185(1):64-71, 2005
                                                              28. Gervais DA et al: Radiofrequency ablation of renal cell carcinoma: part 2, Lessons learned with ablation of 100 tumors. AJR Am J Roentgenol. 185(1):72-80, 2005