Acute and chronic interstitial cryotherapy of the adrenal as a treatment modality

Abstract

Adrenalectomy is indicated for patients with large adrenal lesions or functional tumors. Cryoablation is currently used as a surgical alternative for the treatment of prostate, lung, brain, pharynx, and liver tumors. The purpose of this study was to determine if cryosurgery could be delivered to small areas in the adrenal gland in a controllable and reproducible manner such that tissue could heal in a nonpathologic way. A total of 14 female mongrel dogs underwent acute (n = 8) or chronic (4 weeks, n = 6) cryoablation using the Cryounit. In the acute study using an open transabdominal approach a 2-mm cryoprobe was placed interstitially into the adrenal tissue, whereas 0.032-inch thermocouples were cannulated into the ipsilateral adrenal artery and vein. Adrenal parenchymal temperature changes were measured using 0.032-inch thermocouples placed at 0.4- and 0.8-cm intervals from the cryoprobe. In the chronic study, cryoablation was achieved by transperitoneal laparoscopic access using a standard laparoscopic technique. Interstitial cryoprobe temperatures decreased from 33.1 +/- 1.9 degrees C to -148 +/- 1.2 degrees C following 15 min of freezing in the acute study. Cryoablation of adrenal tissue achieved temperatures of -41.8 +/- 5.7 degrees C and -21.8 +/- 1 degrees C at distances of 0.4 and 0.8 cm from the cryoprobe, respectively. There was no significant change in adrenazl artery or vein temperatures during cryoablation. Histologically there is a clear demarcation between viable and nonviable tissue characterized by areas of multifocal hemorrhage and pyknosis. After 4 weeks of healing a well-defined line of necrotic and viable tissue is visible. Cryoablation of the adrenal can be delivered in an effective, controllable, and reproducible manner. This controllable energy form may provide a new treatment modality for tissue destruction where adrenal gland preservation is necessary and can be performed by the laparoscopic approach. Understanding the effect of adrenal cryoablation may allow us to treat selected patients with small tumors where organ preservation is necessary.

Hemodynamic Changes During Laparoscopic Radiofrequency Ablation of Normal Adrenal Tissue in Dogs

“…7,[11][12][13][14] Thermal ablation of tumors including cryosurgery, microwave ablation, and radiofrequency ablation (RFA) have developed rapidly in human surgery. 7,11,[15][16][17] Most tumor ablation devices currently used clinically in humans use radiofrequency current, which generate frictional heating from ion agitation, i.e. the same process used in electrocautery.…”

Current Role of Laparoscopic Adrenalectomy

“…In our experience, with the patient in the 60° flank position, correct identification of the left renal and adrenal vein is always feasible – even in patients with considerable fibro–fatty retroperitoneum; consequently, we do not believe that a laparoscopic ultrasound probe is necessary during adrenal surgery. Schulsinger et al [33]recently reported their experience when using a cryotherapy probe in the canine model to perform partial adrenal ablation – which, in some cases, may be recommended. Moreover, Janetschek et al [21]and Imai et al [34]reported the feasibility of successful partial adrenalectomy with, in humans, excellent preservation of the adrenal function.…”

"Diagnóstico e tratamento das massas adrenais clinicamente silenciosas: revisão de literatura"

“…Mais recentemente, novas técnicas foram apresentadas, como adrenalectomia por minilaparoscopia (instrumentos menores de 3mm), adrenalectomia robótica com telepresença, crioablação adrenal intersticial, ablação de tumores por radiofreqüência, injeção de ácido acético por via percutânea guiada por TC 15,223,[228][229][230][231][232][233][234][235] .…”