Monitoring renal cryosurgery: predictors of tissue necrosis in swine.

Abstract

To examine parameters for monitoring renal cryosurgery and correlate with histopathologic necrosis in a porcine model. Parameters include: 1) tissue temperature, 2) distance of tissue from the cryosurgical probe insertion site, and 3) inclusion of tissue by the visible iceball. Following midline incision, 6 healthy kidneys from 3 domestic pigs were treated using a nitrogen-based cryosurgical system with 3.4 mm outer diameter cryoprobe. Temperatures were monitored at 6 sites in each kidney using prototype thermocouples. Gross and histologic analysis was performed on tissue harvested from each thermosensor site 24 hours postoperatively. All animals survived to complete the full protocol. Post-procedure bleeding was managed surgically. Histopathology revealed that complete ablation was uniformly produced at temperatures of -19.4C or lower in 13/13 tissue samples. Within 16 mm. of the probe insertion site, cells were uniformly ablated in 17/17 samples while degree of tissue death varied widely beyond this margin. Cell death was more likely found at points encompassed by the visible iceball (16/18, 89%) than those beyond it (2/18, 11%) [p <0.0001, Chi-square] while 2/18 (11%) of samples harvested from within the iceball margin were partially viable. Temperature monitoring using thermocouples during porcine renal cryosurgery demonstrated complete homogeneous necrosis of tissues reaching -19.4C or lower. Distance beyond 16 mm. from the cryoprobe and direct visualization of the iceball proved to be less reliable predictors of tissue necrosis. Management of bleeding post-thaw was necessary in every case.