• Removal of the Kidney (Laparoscopic Nephrectomy)
• Removal of Kidney and Ureter (Laparoscopic Nephroureterectomy)
• Unroofing of Renal Cysts and Renal Biopsy
• Repair of Kidney Obstruction (Laparoscopic Pyeloplasty)
• Removal of the Adrenal Gland (Laparoscopic Adrenalectomy)
• Pelvic Lymph Node Sampling
• Hand Assisted Laparoscopy
• Ureteropyeloscopy
• Cryosurgery
• Extracorporeal Shock Wave Lithotripsy (ESWL)

Cryosurgery involves freezing tissue to extremely cool temperatures (-190 degrees Celsius) in order to kill the cells. The mechanism of this destruction includes disruption of the cell wall, organelles within the cell and prohibiting blood from circulating. With the advent of newer delivery systems and ultrasound guidance one can destroy a focal area of tissue/cancer with accuracy up to 2.5 mm.

• Indications - Dermatologists have the most experience with cryosurgery for treating cancers of the skin. Within the last decade urologists have chosen to use this technology for the treatment of prostate cancer. Most recently other applications have been explored including the use for treating liver cancer bone cancer and kidney cancer. Here at New York Presbyterian we are most interested in utilizing cryosurgery for the treatment and cure of small kidney cancers.

  About half of all patients with kidney cancer are diagnosed "incidentally". That is a test such as an ultrasound or CT scan was ordered for another issue and "incidentally" a kidney tumor was discovered. In small isolated tumors treatment options consist of removing part if not all the kidney. Another treatment option being investigated is cryosurgery of the kidney tumor. Patients with only one kidney or decreased renal function, where removal of a portion or the entire kidney would mean dialysis for life, cryosurgery holds great promise.

• Procedure - Cryosurgery of the kidney is performed laparoscopically. Three ports are placed to allow access to the kidney and site of tumor. Using ultrasound guidance the cryoprobe is placed in the center of the lesion. The probe then is cooled to 90 degrees Celsius creating an ice ball. Using the ultrasound and specially designed temperature probes, the tumor and tissue surrounding it for 1cm. is cooled to 0 degrees Celsius. The advantages of includes minimally invasive (no blood loss, no surgical incision, outpatient surgery), short recuperation period, procedure can be repeated if the first cryosurgery has failed, radical surgery is still an option if the first cryosurgery fails. Picture

• Results - Several investigators including ourselves have performed and followed patients over time undergoing cryosurgery of kidney cancer. Operative time is under 2 hours, hospital stay is 3 days or less, estimated blood loss is negligible and complications are extremely rare. Results in terms of cancer control are promising. Patients on follow-up CT scan have had no evidence of recurrence with follow-up out to 5 years. In patients who underwent biopsy of the cryosurgically-treated cancer no evidence of tumor was identified. This technique has great promise in the arsenal against kidney cancer.