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Silvestri et al. Mini-invasive Surg 2019;3:5 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2018.67

Review Open Access

Laparoscopic ablative techniques

Tommaso Silvestri, Bernardino de Concilio, Guglielmo Zeccolini, Antonio Celia

Urology Unit, “San Bassiano” Hospital, ULSS7 Pedemontana, Bassano del Grappa, VI 36061, Italy.

Correspondence to: Dr. Tommaso Silvestri, Urology Unit, “San Bassiano” Hospital, ULSS7 Pedemontana, Bassano del Grappa,
VI 36061, Italy. E-mail: tommaso.silve@gmail.com

How to cite this article: Silvestri T, de Concilio B, Zeccolini G, Celia A. Laparoscopic ablative techniques. Mini-invasive Surg
2019;3:5. http://dx.doi.org/10.20517/2574-1225.2018.67
Received: 30 Nov 2018 First Decision: 30 Nov 2018 Revised: 28 Jan 2019 Accepted: 11 Feb 2019 Published: 4 Mar 2019

Science Editor: Richard Lawrence John Naspro Copy Editor: Cui Yu Production Editor: Huan-Liang Wu

Abstract
Ablative techniques (AT) offer a combination of nephron-sparing and minimally invasive approaches. AT include
different options and cryoablation (CA) and radiofrequency ablation (RFA) have been relatively safe and traditionally can
be either performed laparoscopically or percutaneously. CA and RFA have emerged as a leading option for renal ablation,
and compared with surgical techniques they offer benefits in preserving renal function with fewer complications, shorter
hospitalization times, and allow for quicker convalescence. A mature dataset exists at this time, with intermediate and
long-term follow up data available. Generally, laparoscopic access was the first technique used in the past, and typically
for anterior and lateral mass. Afterwards, with the improvements in imaging and percutaneous techniques, laparoscopic
approaches are progressively decreased and currently limited in few lesions and in relation with the surgeon’s and
center’s experience. Nevertheless, laparoscopic CA and RFA could be useful techniques and currently, recommendations
as a first-line therapy are made at this time in limited populations, including elderly patients, patients with multiple
comorbidities, and those with imperative indications of a nephron sparing surgery. As more data emerge on oncologic
efficacy, and technical experience continue to improve, the application of AT will likely be extended in future treatment
guidelines and laparoscopic approaches will be a valid option in the era of tailored therapy.

Keywords: Laparoscopic kidney cryoablation, small renal masses, laparoscopic ablative techniques

INTRODUCTION
Although surgery remains the definitive recommended treatment of small renal masses (SRM), ablative
techniques (AT) have emerged recently, particularly for tumors < 4 cm, and for those patients who
cannot undergo surgery or with imperative indications of nephron sparing surgery (NSS). AT included:
cryoablation (CA), radiofrequency ablation (RFA), microwave ablation, laser thermal ablation, and high-
intensity focused ultrasound. Historically CA and RFA have been introduced first worldwide, and recently

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
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sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
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