Treatment

Based on the results of your tests, you and your doctor will decide whether or not it is advisable to treat your kidney tumor by freezing it - cryotherapy.

Kidney tumors are treated with cryoablation by placing one or more fine needles into the tumor which are then cooled to below -100oC. The procedure can be carried out either through a traditional open incision or by choosing a minimally invasive method that is performed either under laparoscopic or CT/MRI guidance. Your recovery depends in large part on which of these approaches is taken. Depending on your health as well as the size and location of the tumor, your surgeon will discuss the different guidance methods available.

Laparoscopic Guided

Laparoscopic cryoablation of kidney tumors typically involves three or four small incision in order for the surgeon to isolate the kidney tumor. Nearby organs such as the colon, liver or spleen as well as large blood vessels are moved away from the tumor so that they are not injured by the freezing process. Finally, the needles are passed through the skin and are precisely positioned into the tumor in such as way to ensure that the entire tumor and a small margin of normal kidney are thoroughly frozen. Procedure is guided and monitored by ultrasound imaging.

CT/MRI-Guided

In CT/MRI-guided cryotherapy, the surgeon operates while viewing a 3D image taken by CT or MRI scans. In the CT/MRI-guided procedure, ultra-thin needles are thermal sensors are inserted.

Open

The kidney is identified and isolate, and cryotherapy is performed under direct vision.

Your Consent

We will need your permission for your operation to go ahead. Before you sign the consent form it is important that you understand the risks and effects of the operation and anaesthetic. These will be discussed with you by your doctor and the nurse, should you have any questions, your nurse or doctor would be happy to answer these.

About Your Anaesthetic

Depending on the required approach to the kidney you and your surgeon will decide whether regional or general anaesthetic should be used.

• General Anaesthetic: Patients are asleep throughout the operation and remember nothing of it. For young children, gas is given through a small mask, which puts the child off to sleep and avoids the need for the insertion of a needle while the child is awake. However, as soon as the child is asleep, a drip is put in for safety reasons.
• Regional Anaesthetic e.g. Spinal, Epidural or Caudal: A needle is placed into the back and a solution is injected that numbs the body from the waist down. Patients are awake but maybe sleepy and do not feel the operation. For young children a general anaesthetic is usually combined with a caudal. This ensures the child is asleep during the operation, but when they wake, the caudal continues to work for several hours blocking the nerve supply to the penis and preventing pain.

Feel free to discuss these options, and any questions with the anaesthetist.

You must not drive any vehicle or operate any machinery for 24 hours after having an anaesthetic. Arrangements would need to be made for transport to get home.

Your Operation

No special diet is required prior to your procedure. You will be admitted to the hospital the day before the surgery or the morning of your operation, You will be instructed when to stop eating and drinking. Your doctor will make a mark on your body to indicate which kidney is to be operated on.

The operation typically takes two to three hours, but operative time is variable.

After Surgery

You will wake up in the recovery room. Your vital signs will be monitored regularly as will your urinary output. You will have a  catheter and possibly a drain. You may want to discuss this with your doctor prior to surgery. You will have dressings over any incisions and where the cryoablation needles were placed.

You will be able to drink fluids immediately after your surgery and then food if you are managing to take fluids well.

Pain relief may be necessary after the procedure related to the open surgery or laparoscopic approach. You may be given painkillers by mouth and possible a suppository. the aim will be to make you as comfortable as possible. It mus be said that many patients experience very little pain after the procedure but each patient is treated individually.

You will stay in the hospital until you are eating, drinking, walking and urinating satisfactorily. This may involve staying only one night in the hospital after your procedure. Additionally, if there are any complications after your operation, you may need to stay in the hospital longer.

Going Home

You will be seen a few weeks after your surgery to discuss the results of your biopsy and to make sure that you are making a good recovery. Scans  (CT or MRI) are carried out at regular intervals following the treatment in order to ensure the treatment has been successful. Your doctor will discuss this will you in terms of setting a schedule. These scans become less frequent provided the results are satisfactory.

Your recovery time greatly depends upon the approach of the procedure (Laparoscopic, CT/MRI-guided, Open). By the time you leave the hospital you will be able to do basic things for yourself such as washing and dressing.

It is wise not drive for at least four weeks after the procedure and you should not drive if you are in any pain. Check with your insurance company to ensure that you have proper coverage before driving.

Once Home

Once your wounds are dry you can shower or bathe. You will need to build up your appetite and your strength. You will find that you are very tired when you go home and you will need to rest during the day. You will gradually be able to do more and more by building up you activities.

It is wise not to do any heavy lifting or very strenuous activities for at least six weeks. Driving and activities after laparoscopic procedures may be able to resume after two weeks. There are no hard and fast rules but generally you can do activities provided they do not hurt.

Going back to work depends on the nature of your work and how fit you feel.

Are there any possible complications?

Complications can occur after any procedure but your doctors and nurses will do everything possible to avoid these. Some complications may occur at he time of surgery and others at a later point during your recovery. Complications that can occur after any surgery include problems with general anaesthesia or cardiovascular problems. While these problems rarely occur, the risk to you does depend on your fitness for surgery and any other previous medical problems that you may have. Your overall risk is worthwhile discussing with your doctor. The risk of these complications following this particular procedure are minimised compared to traditional surgery because of the small wounds and lower risk of bleeding. You can help prevent some of these complications by carefully returning to activities, such as walking after surgery.

Great care is taken during the procedure to avoid any injuries that could occur  such as injury to nearby structures (bleeding from kidney, injury to blood vessels or spleen for example).

Any possible complications will be discussed with you by your doctor and the nurse before the procedure. Should you have any questions, your nurse or doctor would be happy to answer these.

You will be instructed to call your doctor or specialist nurse if you have:

• Fever or chills
• Nausea or vomiting
• Urine that is cloudy or smells
• Persistent abdominal or back pain
• Signs of infection in a wound. This may take form of foul smelling discharge or redness spreading from the sides of the wound.

Will I need further treatments?

Depending on the success of your operation, based on the follow up scans, further treatment may be necessary. Occasionally, it is necessary to repeat the cryoblation procedure or even to remove the kidney. The likelihood of needed further treatment depends in large part on the size and location of the kidney tumor. Your doctor will discuss this with you.

While you are in hospital we will do everything we can to make your stay as comfortable as possible. The nursing and medical staff are always available to help with whatever needs you have. If you are worried about anything before or after your surgery, or if you have any further questions or would like more information, please do not hesitate to ask your nurse who will be more than happy to help.