7. Zlotta, A. R., Wildschutz, T., Raviv, G., Peny, M. O., vanGansbeke, D., Noel, J. C. et al: Radiofrequency interstitialtumor ablation (RITA) is a possible new modality for treat-ment of renal cancer: ex vivo and in vivo experience. JEndourol, 11: 251, 1997

8. McGovern, F. J., Wood, B. J., Goldberg, S. N. and Mueller, P. R.:Radiofrequency ablation of renal cell carcinoma via imageguided needle electrodes. J Urol, 161: 599, 1999

9. Gervais, D. A., McGovern, F. J., Wood, B. J., Goldberg, S. N.,McDougal, W. S. and Mueller, P. R.: Radio-frequency ablationof renal cell carcinoma: early clinical experience. Radiology,217: 665, 2000

10. Pavlovich, C. P., Walther, M. M., Choyke, P. L., Paulter, S. E., Chang,R., Linehan, W. M. et al: Percutaneous radiofrequency ablation ofsmall renal tumors: initial results. J Urol, 167: 10, 2002

11. Gettman, M. T., Bishoff, J. T., Su, L. M., Chan, D., Kavoussi,L. R., Jarrett, T. W. et al: Hemostatic laparoscopic partialnephrectomy: initial experience with the radiofrequencycoagulation-assisted technique. Urology, 58: 8, 2001

12. Yohannes, P., Pinto, P., Rotariu, P., Smith, A. D. and Lee, B. R.:Retroperitoneoscopic radiofrequency ablation of a solid renalmass. J Endourol, 15: 845, 2001

13. Crowley, J. D., Shelton, J., Iverson, A. J., Burton, M. P.,Dalrymple, N. C. and Bishoff, J. T.: Laparoscopic and com-puted tomography-guided percutaneous radiofrequency abla-tion of renal tissue: acute and chronic effects in an animalmodel. Urology, 57: 976, 2001

14. Corwin, T. S., Lindberg, G., Traxer, O., Gettman, M. T., Smith,T. G., Pearle, M. S. et al: Laparoscopic radiofrequency thermalablation of renal tissue with and without hilar occlusion.J Urol, 166: 281, 2001

15. Schulman, C. and Zlotta, A.: Transurethral needle ablation ofthe prostate (TUNA): pathological, radiological and clinicalstudy of a new office procedure for treatment of benign pros-tatic hyperplasia using low-level radiofrequency energy. ArchEsp Urol, 47: 895, 1994

16. Hsu, T. H., Fidler, M. E. and Gill, I. S.: Radiofrequency ablationof the kidney: acute and chronic histology in porcine model.Urology, 56: 872, 2000

17. Rendon, R. A., Kachura, J. R., Sweet, J. M., Gertner, M. R.,Sherar, M. D., Robinette, M. et al: The uncertainty of radiofrequency treatment of renal cell carcinoma: findings at im-mediate and delayed nephrectomy. J Urol, 167: 1587, 2002

18. Shingleton, W. B. and Sewell, P. E., Jr.: Percutaneous renaltumor cryoablation with magnetic resonance imaging guid-ance. J Urol, 165: 773, 2001

EDITORIAL COMMENT

These authors present a retrospective review of the proceduraloutcome in 13 patients who underwent laparoscopic radio frequency

ablation or laparoscopic partial nephrectomy after radio frequencyablation for enhancing solid renal masses. They describe an inno-vative technique. This well-defined cohort had a short but rigor-ous mean followup of 9.8 months and only 3 patients had 12-month CT scans. I share the author view that laparoscopic partialnephrectomy is preferable to in situ ablation for a number ofreasons. There is the certainty of complete treatment with patho-logically confirmed negative margins with partial nephrectomy.The sensitivity and specificity of subtle abnormalities are uncer-tain on radiographic followup after in situ ablation. Of 11 in situlesions 6 were visible on post-procedure imaging with a variabledecrease in size in this series. Post-cryotherapy recurrences havebeen reported even after initial negative biopsies at 6 months.1There is a high burden of radiographic followup with undeter-mined end points. For instance, how many more imaging studieswould 18-year-old patient 6 have in her lifetime than if she hadundergone laparoscopic or open partial nephrectomy? In addition,posttreatment percutaneous biopsies have poor precision and re-liability after in situ treatment. Lechevallier et al noted only 63%accuracy for helical CT guided biopsy of solid renal masses lessthan 3 cm.2 Dechet et al observed a large degree of inaccuracy inrenal biopsy even during open biopsy in patients undergoing ne-phrectomy for renal masses.3

The potential advantage of laparoscopic radio frequency is techni-cal ease and no need for vascular control, which is offset the onco-logical concerns outlined. Although promising, our enthusiasmshould be tempered by the fact that there are only about 50 cases inthe literature of human radio frequency renal ablation in its variousforms (references 7 to 12 in article). This report supports the safetyof the procedure, although confirmation of efficacy awaits more pa-tients with longer followup and more rigorously determined out-comes.

Christopher J. KaneDepartment of UrologyUniversity of California-San FranciscoSan Francisco, California

1. Levin, H. S., Meraney, A. M., Novick, A. C. and Gill, I. S.: Needlebiopsy histology of renal tumors 3- and 6 months after lapa-roscopic renal cryoablation. J Urol, suppl., 163: 153, abstract682, 2000

2. Lechevallier, E., Andre, M., Barriol, D. et al: Fine-needle percu-taneous biopsy of renal masses with helical CT guidance.Radiology, 216: 506, 2000

3. Dechet, C. B., Sebo, T., Farrow, G. et al: Prospective analysis ofintraoperative frozen needle biopsy of solid renal masses inadults. J Urol, 162: 1282, 1999

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