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Name:
Microwave Ablation of Renal Cell Carcinoma
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Microwave Ablation of Renal Cell Carcinoma
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T00H17M21S
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Upload Date:
2023-10-19T00:00:00.0000000
Transcript:
Language: EN.
Segment:1 TITLE + INDICATIONS.
[MUSIC PLAYING]
SPEAKER 1: In this video, we will be discussing microwave ablation of renal cell carcinoma at the University of Wisconsin Madison.
JASON ABEL: When we see a patient with small renal mass in clinic, we discuss three primary options for treatment-- surgery, active surveillance, and thermal ablation. As part of the shared decision making process, we discuss these options with all the patients. All patients who are considering ablation get a biopsy prior to the day of ablation. We do this for several reasons. First, it improves the informed consent process.
JASON ABEL: Some patients who have an oncocytic neoplasm may not decide to have an active treatment. Second, biopsies that are obtained at the same time of ablation do have a higher chance of being non-diagnostic. And because cancer patients require longer term follow-up, we want to establish that diagnosis prior to treatment. All patients are first seen by a urologist in the Urology Clinic.
JASON ABEL: They're also followed afterward for cancer surveillance in the Urology Clinic. The patients that are selected who are offered thermal ablation are generally patients with smaller renal tumors who have a risk profile that is more favorable for ablation-- for example, patients who have some comorbidities and who also desire an active treatment and do not want to be put on surveillance.
JASON ABEL: I think one of the things that makes the ablation program of the University of Wisconsin unique is the close collaboration and the synergy between urologists and abdominal radiologists. We have a weekly online meeting where we review images and the pathology of the clinical information of the patients who are being considered and schedule for ablation. Radiologists and surgeons really have complementary fonts of knowledge.
JASON ABEL: And I believe the synergy really enables excellent clinical outcomes.
SPEAKER 3: So I think we'll have to see whether we can cover that with one probe, or not. But I think the biggest thing is just the tight space.
JASON ABEL: Some of the technical aspects that we discuss on every patient through conference are how this patient is going to be positioned on the table-- either in a lateral position or prone-- what approach will be used to insert the tumor, are we going to target under a certain rib, or a different approach, whether we really use fluoroscopy, or ultrasound guidance, or some of the more advanced techniques, whether this tumor will require hydrodissection, which is displacement of the adjacent structures using saline solution, the type of probe that is going to be used, the length of the probe that will be needed, the number of probes that we used.
JASON ABEL: So we really go into each ablation case with a solid game plan.
SPEAKER 1: Rare complications that are discussed with patients include risk of damage to surrounding structures, such as the colon or pancreas, pain, bleeding, urinoma, and nerve injury. Local recurrence rates are slightly higher with ablation compared to surgery, but may be salvaged with a second ablation procedure, in most patients. Metastatic recurrence and cancer specific mortality are not significantly different between surgery and ablation.
FRED LEE: The use of microwave ablation for kidney cancer At the University of Wisconsin was a natural convergence of two separate pathways that were happening in our university over the last couple of decades. The first is that we had some natural growth in our clinical ablation program in liver, kidney, lung, and in soft tissues, that had been happening somewhat organically.
FRED LEE: We were using cryoablation and radiofrequency ablation primarily for this purpose. And we were starting to attract patients that came to UW for ablation from all over the Midwest and all over the country. The parallel development that was happening at that time is we had a tumor ablation laboratory, one of the first of its type here in the United States. And we were investigating some new methods to perform thermal tumor ablation, primarily using microwave in our laboratory.
FRED LEE: We had been looking at some existing commercial systems. And over the course of our investigations, two of our scientists, Dan van der Weide and Chris Brace, had invented a triaxial microwave antenna that was highly efficient for use in heating tissue. And we started studying this in some depth. We did a number of animal studies. And it turned out that the device was very successful for creating very rapid tissue heating and a very thorough ablation.
SPEAKER 1: Cryoablation, radio frequency, and microwave ablation have all been used successfully to treat renal cell carcinoma. Here at the University of Wisconsin, we favor microwave ablation, using the new wave machine that was developed here. We favor this over radio frequency because of the more rapid heating, reproducible cell kill, and the highly visible ablation zone formed by water vapor that corresponds well to the zone of necrosis.
SPEAKER 1: For more central tumors, we favor cryoablation, due to the slower formation of the ablation zone and the less likelihood of damage to the collecting system.
Segment:2 PRE-OPERATIVE PLANNING.
MARCI ALEXANDER: Once the biopsy has been resulted and you know you're moving forward with the possibility of an ablation, these are the things that I do to get the patient ready. So using this sheet as my guide, I start from the beginning with the patient's comorbidities, or past medical history. And some renal patients have almost nothing and other renal patients have a very complex past medical history.
MARCI ALEXANDER: So starting there and identifying what that looks like-- and some of the issues that would come up are what's a patient's creatinine? So we want to know that. It's definitely not a deal breaker for ablation. But at our program here at UW, we use contrast at the end of the procedure, using CT contrast to ensure that we have treated the entire tumor.
MARCI ALEXANDER: So their creatinine is very important. We also do an added appointment, often a clinic appointment, or we here call it the planning ultrasound. At this time, we evaluate what position can we see this best with ultrasound? Is it in an area in the kidney where the ureter is a concern? Are you central? Do you need a stent?
JASON ABEL: When tumors are located directly adjacent to the collecting system, we will occasionally place a ureteral stent. This is generally removed about one month postoperatively.
Segment:3 ANESTHESIA.
TIM MCCORMICK: For The anesthesia perspective, we use a technique called jet ventilation. And we use a monsoon jet ventilator, which is a jet ventilating machine, as opposed to-- previously, we used to use a hand-controlled jet ventilation. So this is kind of a step up from jet ventilation of the past. Basically, we do the jet ventilation throughout the case, do an IV infusion of medication to keep the patient asleep, and this allows for the patient to remain still and less need for breath holds and things like that.
TIM MCCORMICK: It causes less motion throughout the case, to get more accurate for abdominal organ ablation. So this is the monsoon jet ventilator. It's a little bit different than our normal ventilator, basically a very simple pressure control ventilator. These are generally the normal settings that we have them on. The most interesting one is the frequency of 120 breaths per minute, very fast for very small tidal volumes.
TIM MCCORMICK: We do have a transcutaneous CO2 monitor. It's kind of optional, but it's helped us guide our ventilation strategy throughout the case. We do a TIVA, which is a propofol infusion for the case, because this does not use volatile anesthetic. And then, have our normal ventilator as a backup, for backup ventilation, if this were to fail, or if we need to change ventilation strategy. The tube's the same.
TIM MCCORMICK: Everything else is the same, except for this connector piece here, which we'll demonstrate in vivo. The jet ventilation tube-- it goes through the endotracheal tube, right? We can use a normal circuit, or we can change it to the jet ventilator. So either way works. These connectors have gone here.
TIM MCCORMICK: And off we go.
Segment:4 POSITIONING.
MARCI ALEXANDER: So what we have recommended here at UW Hospital is a decub position, or the treatment side is up. So if we are treating a right RCC, then we would be left lateral decub, left side down. So the patient's in a prayer position. All bony prominence are protected, pillow between their knees and ankles. And then for anesthesia purposes, we use what we call an axroll, or the axillary roll, which goes right at their breast.
MARCI ALEXANDER: And that is to protect from brachial plexus and any sort of nerve pinching that could be established during decub. Another point that you might want to consider with positioning is a flank roll. So some patients, when they lay in a decub position, right at their flank, it sort of drops in. And that's often where you're placing your probe. So using a flank roll elevates that, brings the kidney a little closer.
MARCI ALEXANDER: And again, it's so helpful in getting you to that lesion safely.
Segment:5 INITIAL IMAGING AND TARGETING.
SPEAKER 1: After the patient is positioned, we use ultrasound guidance to visualize the mass and mark the target site for probe insertion. The patient is then prepped with chlorhexidine and draped with a combination of blue towels, Tegaderms, and a surgical drape to complete the sterile field.
Segment:6 PROBE INSERTION.
SPEAKER 1: The probe is first tested by placing it in normal saline and ensuring a good seal is intact with no air bubbles visualized.
SPEAKER 1: The skin is then marked with the probe. An incision is then made with an 11 blade scalpel at our previously marked site. Using ultrasound guidance, the probe is then inserted to the desired location in the tumor. In general, for exoteric tumors, we bias probe placement slightly towards the kidney, because that is where the blood supply, and thus the cooling, are coming from.
SPEAKER 1: This red arrow is pointing to the targeted tumor. CT guidance is then used to confirm the probe has been advanced into the appropriate position. This 3D reconstruction demonstrates the probe's position from all angles, with the area highlighted in green representing the tumor.
Segment:7 ABLATION.
SPEAKER 1: Standard ablation settings are at a power of 65 watts for a maximum ablation time of five minutes.
SPEAKER 1: The probe temperatures are closely watched throughout the duration of the ablation. This red arrow demonstrates the first bubble, or pop, at the tip of the probe. Here, you can see the second bubble, which is near the emission point and should be aimed towards the middle of the tumor in small masses. The total length of ablation with our settings is around 3.5 centimeters with a max width of 3 centimeters.
SPEAKER 1: The gas bubbles roughly outline the ablation zone. But over time, they start to diffuse away from the ablation into the perirenal, fat, and subcapsular space. A CT with IV contrast is then performed to visualize the ablation zone in its entirety and ensure a complete ablation of the tumor. One advantage of this is that any residual tumor can then be treated immediately, if necessary. In this post ablation, scan the tumor itself is smaller than the pre-ablation, due to intense tissue dehydration from the microwaves.
SPEAKER 1: This results in an impressive contraction of the tumor, as demonstrated in this tissue model. You can see a small margin that has been taken out of the rental cortex. Additionally, the ablation zone is seen extending into the perirenal fat.
SPEAKER 7: You can kind of see there the margin of the ablation. And then the tumor is right there.
Segment:8 HYDRODISSECTION.
SPEAKER 1: Complications can increase with centrally located tumors, those near the collecting system, or those near critical organs, such as the pancreas, spleen, or colon. A technique called hydrodissection can be employed to dissect critical structures away from the tumor, so as to prevent collateral damage from the ablation zone.
SPEAKER 7: Put that on the three-way stopcock. And then we put it all together like this. So this would go to the needle. This will go to the bag. We'll suction it out of the bag and push it out through the needle by switching the stopcock.
SPEAKER 1: A spinal needle is inserted into the proper plane between the tumor and the critical structure of question using ultrasound or CT fluoroscopic guidance. A mixture of normal saline and omnipaque contrast is then injected via the spinal needle using a 60 cc syringe and three-way stopcock. The use of contrast allows the hydrodissection process to be performed under CT fluoroscopy guidance, ensuring adequate separation of the mass from the critical structure.
SPEAKER 1: If needed, additional hydrodissection can be performed under ultrasound guidance. The hydrodissection apparatus is reconnected. Additional fluid is instilled to create a safer ablation zone around the kidney mass. Hydrodissection was a critical technique in this patient whose tumor was located in close proximity to her pancreas.
SPEAKER 1: She Additionally required multiple probes, given the size of her tumor. Here, you can see how the hydrodissection has nicely separated the tumor from the pancreas and colon. The contrast used in the fluid, as demonstrated by this purple arrow, allows you to clearly visualize the new plane you have created. She was a 70-year-old female with a history of diabetes, hyperlipidemia, hypertension, end stage renal disease on dialysis, and coronary artery disease, with a recent MI and stent placement eight months prior.
SPEAKER 1: Her biopsy confirmed hybrid oncocytic chomophobe tumor. And given her extensive comorbidities, she decided to proceed with ablation. Pictured on the left is her pre-ablation MRI. On the right is her post ablation CT scan.
Segment:9 WOUND CARE / DRESSING.
SPEAKER 1: The site is cleaned and dried. Dermabond is then applied over the puncture site. The patient is woken up, extubated, and taken back to PACU.
Segment:10 POST OP CARE + SECRETS TO SUCCESS.
SPEAKER 1: Patients are either observed and discharged the same day, or admitted for observation overnight. We generally admit patients with greater than 3 centimeter tumors, solitary kidneys, or concern for hematoma. Hematocrit is obtained four hours post procedure. They are given a general diet post op day 0 and analgesics, as needed. Follow-up consists of an MRI within and without contrast, or a CT, if MRI is contraindicated, chest X-ray, BMP, CBC, and CRP in six months.
SPEAKER 1: Our secrets to success here at the University of Wisconsin include the following-- obtaining a biopsy prior to the day of ablation to ensure the patient has informed consent prior to the procedure, our multidisciplinary team, which includes urologists, abdominal radiologists, and ultrasonographers, who all work together to achieve the best outcome, employing ventilation with anesthesia, which allows for minimal organ movement with inspiration throughout the procedure, managing the collecting system with the stent when necessary, using hydro dissection to displace adjacent structures and create a safe ablation zone, real-time monitoring with ultrasound and CT guidance, and contrasted imaging at the conclusion of the procedure, which shows residual tumor with the option for immediate treatment, if necessary.
SPEAKER 1: Percutaneous microwave ablation is an effective and safe treatment option for renal cell carcinoma in both T1a and T1b tumors in selected patients, with multiple studies showing excellent oncologic outcomes, when compared to partial and radical nephrectomy.
Segment:1 TITLE + INDICATIONS.
[MUSIC PLAYING]
SPEAKER 1: In this video, we will be discussing microwave ablation of renal cell carcinoma at the University of Wisconsin Madison.
JASON ABEL: When we see a patient with small renal mass in clinic, we discuss three primary options for treatment-- surgery, active surveillance, and thermal ablation. As part of the shared decision making process, we discuss these options with all the patients. All patients who are considering ablation get a biopsy prior to the day of ablation. We do this for several reasons. First, it improves the informed consent process.
JASON ABEL: Some patients who have an oncocytic neoplasm may not decide to have an active treatment. Second, biopsies that are obtained at the same time of ablation do have a higher chance of being non-diagnostic. And because cancer patients require longer term follow-up, we want to establish that diagnosis prior to treatment. All patients are first seen by a urologist in the Urology Clinic.
JASON ABEL: They're also followed afterward for cancer surveillance in the Urology Clinic. The patients that are selected who are offered thermal ablation are generally patients with smaller renal tumors who have a risk profile that is more favorable for ablation-- for example, patients who have some comorbidities and who also desire an active treatment and do not want to be put on surveillance.
JASON ABEL: I think one of the things that makes the ablation program of the University of Wisconsin unique is the close collaboration and the synergy between urologists and abdominal radiologists. We have a weekly online meeting where we review images and the pathology of the clinical information of the patients who are being considered and schedule for ablation. Radiologists and surgeons really have complementary fonts of knowledge.
JASON ABEL: And I believe the synergy really enables excellent clinical outcomes.
SPEAKER 3: So I think we'll have to see whether we can cover that with one probe, or not. But I think the biggest thing is just the tight space.
JASON ABEL: Some of the technical aspects that we discuss on every patient through conference are how this patient is going to be positioned on the table-- either in a lateral position or prone-- what approach will be used to insert the tumor, are we going to target under a certain rib, or a different approach, whether we really use fluoroscopy, or ultrasound guidance, or some of the more advanced techniques, whether this tumor will require hydrodissection, which is displacement of the adjacent structures using saline solution, the type of probe that is going to be used, the length of the probe that will be needed, the number of probes that we used.
JASON ABEL: So we really go into each ablation case with a solid game plan.
SPEAKER 1: Rare complications that are discussed with patients include risk of damage to surrounding structures, such as the colon or pancreas, pain, bleeding, urinoma, and nerve injury. Local recurrence rates are slightly higher with ablation compared to surgery, but may be salvaged with a second ablation procedure, in most patients. Metastatic recurrence and cancer specific mortality are not significantly different between surgery and ablation.
FRED LEE: The use of microwave ablation for kidney cancer At the University of Wisconsin was a natural convergence of two separate pathways that were happening in our university over the last couple of decades. The first is that we had some natural growth in our clinical ablation program in liver, kidney, lung, and in soft tissues, that had been happening somewhat organically.
FRED LEE: We were using cryoablation and radiofrequency ablation primarily for this purpose. And we were starting to attract patients that came to UW for ablation from all over the Midwest and all over the country. The parallel development that was happening at that time is we had a tumor ablation laboratory, one of the first of its type here in the United States. And we were investigating some new methods to perform thermal tumor ablation, primarily using microwave in our laboratory.
FRED LEE: We had been looking at some existing commercial systems. And over the course of our investigations, two of our scientists, Dan van der Weide and Chris Brace, had invented a triaxial microwave antenna that was highly efficient for use in heating tissue. And we started studying this in some depth. We did a number of animal studies. And it turned out that the device was very successful for creating very rapid tissue heating and a very thorough ablation.
SPEAKER 1: Cryoablation, radio frequency, and microwave ablation have all been used successfully to treat renal cell carcinoma. Here at the University of Wisconsin, we favor microwave ablation, using the new wave machine that was developed here. We favor this over radio frequency because of the more rapid heating, reproducible cell kill, and the highly visible ablation zone formed by water vapor that corresponds well to the zone of necrosis.
SPEAKER 1: For more central tumors, we favor cryoablation, due to the slower formation of the ablation zone and the less likelihood of damage to the collecting system.
Segment:2 PRE-OPERATIVE PLANNING.
MARCI ALEXANDER: Once the biopsy has been resulted and you know you're moving forward with the possibility of an ablation, these are the things that I do to get the patient ready. So using this sheet as my guide, I start from the beginning with the patient's comorbidities, or past medical history. And some renal patients have almost nothing and other renal patients have a very complex past medical history.
MARCI ALEXANDER: So starting there and identifying what that looks like-- and some of the issues that would come up are what's a patient's creatinine? So we want to know that. It's definitely not a deal breaker for ablation. But at our program here at UW, we use contrast at the end of the procedure, using CT contrast to ensure that we have treated the entire tumor.
MARCI ALEXANDER: So their creatinine is very important. We also do an added appointment, often a clinic appointment, or we here call it the planning ultrasound. At this time, we evaluate what position can we see this best with ultrasound? Is it in an area in the kidney where the ureter is a concern? Are you central? Do you need a stent?
JASON ABEL: When tumors are located directly adjacent to the collecting system, we will occasionally place a ureteral stent. This is generally removed about one month postoperatively.
Segment:3 ANESTHESIA.
TIM MCCORMICK: For The anesthesia perspective, we use a technique called jet ventilation. And we use a monsoon jet ventilator, which is a jet ventilating machine, as opposed to-- previously, we used to use a hand-controlled jet ventilation. So this is kind of a step up from jet ventilation of the past. Basically, we do the jet ventilation throughout the case, do an IV infusion of medication to keep the patient asleep, and this allows for the patient to remain still and less need for breath holds and things like that.
TIM MCCORMICK: It causes less motion throughout the case, to get more accurate for abdominal organ ablation. So this is the monsoon jet ventilator. It's a little bit different than our normal ventilator, basically a very simple pressure control ventilator. These are generally the normal settings that we have them on. The most interesting one is the frequency of 120 breaths per minute, very fast for very small tidal volumes.
TIM MCCORMICK: We do have a transcutaneous CO2 monitor. It's kind of optional, but it's helped us guide our ventilation strategy throughout the case. We do a TIVA, which is a propofol infusion for the case, because this does not use volatile anesthetic. And then, have our normal ventilator as a backup, for backup ventilation, if this were to fail, or if we need to change ventilation strategy. The tube's the same.
TIM MCCORMICK: Everything else is the same, except for this connector piece here, which we'll demonstrate in vivo. The jet ventilation tube-- it goes through the endotracheal tube, right? We can use a normal circuit, or we can change it to the jet ventilator. So either way works. These connectors have gone here.
TIM MCCORMICK: And off we go.
Segment:4 POSITIONING.
MARCI ALEXANDER: So what we have recommended here at UW Hospital is a decub position, or the treatment side is up. So if we are treating a right RCC, then we would be left lateral decub, left side down. So the patient's in a prayer position. All bony prominence are protected, pillow between their knees and ankles. And then for anesthesia purposes, we use what we call an axroll, or the axillary roll, which goes right at their breast.
MARCI ALEXANDER: And that is to protect from brachial plexus and any sort of nerve pinching that could be established during decub. Another point that you might want to consider with positioning is a flank roll. So some patients, when they lay in a decub position, right at their flank, it sort of drops in. And that's often where you're placing your probe. So using a flank roll elevates that, brings the kidney a little closer.
MARCI ALEXANDER: And again, it's so helpful in getting you to that lesion safely.
Segment:5 INITIAL IMAGING AND TARGETING.
SPEAKER 1: After the patient is positioned, we use ultrasound guidance to visualize the mass and mark the target site for probe insertion. The patient is then prepped with chlorhexidine and draped with a combination of blue towels, Tegaderms, and a surgical drape to complete the sterile field.
Segment:6 PROBE INSERTION.
SPEAKER 1: The probe is first tested by placing it in normal saline and ensuring a good seal is intact with no air bubbles visualized.
SPEAKER 1: The skin is then marked with the probe. An incision is then made with an 11 blade scalpel at our previously marked site. Using ultrasound guidance, the probe is then inserted to the desired location in the tumor. In general, for exoteric tumors, we bias probe placement slightly towards the kidney, because that is where the blood supply, and thus the cooling, are coming from.
SPEAKER 1: This red arrow is pointing to the targeted tumor. CT guidance is then used to confirm the probe has been advanced into the appropriate position. This 3D reconstruction demonstrates the probe's position from all angles, with the area highlighted in green representing the tumor.
Segment:7 ABLATION.
SPEAKER 1: Standard ablation settings are at a power of 65 watts for a maximum ablation time of five minutes.
SPEAKER 1: The probe temperatures are closely watched throughout the duration of the ablation. This red arrow demonstrates the first bubble, or pop, at the tip of the probe. Here, you can see the second bubble, which is near the emission point and should be aimed towards the middle of the tumor in small masses. The total length of ablation with our settings is around 3.5 centimeters with a max width of 3 centimeters.
SPEAKER 1: The gas bubbles roughly outline the ablation zone. But over time, they start to diffuse away from the ablation into the perirenal, fat, and subcapsular space. A CT with IV contrast is then performed to visualize the ablation zone in its entirety and ensure a complete ablation of the tumor. One advantage of this is that any residual tumor can then be treated immediately, if necessary. In this post ablation, scan the tumor itself is smaller than the pre-ablation, due to intense tissue dehydration from the microwaves.
SPEAKER 1: This results in an impressive contraction of the tumor, as demonstrated in this tissue model. You can see a small margin that has been taken out of the rental cortex. Additionally, the ablation zone is seen extending into the perirenal fat.
SPEAKER 7: You can kind of see there the margin of the ablation. And then the tumor is right there.
Segment:8 HYDRODISSECTION.
SPEAKER 1: Complications can increase with centrally located tumors, those near the collecting system, or those near critical organs, such as the pancreas, spleen, or colon. A technique called hydrodissection can be employed to dissect critical structures away from the tumor, so as to prevent collateral damage from the ablation zone.
SPEAKER 7: Put that on the three-way stopcock. And then we put it all together like this. So this would go to the needle. This will go to the bag. We'll suction it out of the bag and push it out through the needle by switching the stopcock.
SPEAKER 1: A spinal needle is inserted into the proper plane between the tumor and the critical structure of question using ultrasound or CT fluoroscopic guidance. A mixture of normal saline and omnipaque contrast is then injected via the spinal needle using a 60 cc syringe and three-way stopcock. The use of contrast allows the hydrodissection process to be performed under CT fluoroscopy guidance, ensuring adequate separation of the mass from the critical structure.
SPEAKER 1: If needed, additional hydrodissection can be performed under ultrasound guidance. The hydrodissection apparatus is reconnected. Additional fluid is instilled to create a safer ablation zone around the kidney mass. Hydrodissection was a critical technique in this patient whose tumor was located in close proximity to her pancreas.
SPEAKER 1: She Additionally required multiple probes, given the size of her tumor. Here, you can see how the hydrodissection has nicely separated the tumor from the pancreas and colon. The contrast used in the fluid, as demonstrated by this purple arrow, allows you to clearly visualize the new plane you have created. She was a 70-year-old female with a history of diabetes, hyperlipidemia, hypertension, end stage renal disease on dialysis, and coronary artery disease, with a recent MI and stent placement eight months prior.
SPEAKER 1: Her biopsy confirmed hybrid oncocytic chomophobe tumor. And given her extensive comorbidities, she decided to proceed with ablation. Pictured on the left is her pre-ablation MRI. On the right is her post ablation CT scan.
Segment:9 WOUND CARE / DRESSING.
SPEAKER 1: The site is cleaned and dried. Dermabond is then applied over the puncture site. The patient is woken up, extubated, and taken back to PACU.
Segment:10 POST OP CARE + SECRETS TO SUCCESS.
SPEAKER 1: Patients are either observed and discharged the same day, or admitted for observation overnight. We generally admit patients with greater than 3 centimeter tumors, solitary kidneys, or concern for hematoma. Hematocrit is obtained four hours post procedure. They are given a general diet post op day 0 and analgesics, as needed. Follow-up consists of an MRI within and without contrast, or a CT, if MRI is contraindicated, chest X-ray, BMP, CBC, and CRP in six months.
SPEAKER 1: Our secrets to success here at the University of Wisconsin include the following-- obtaining a biopsy prior to the day of ablation to ensure the patient has informed consent prior to the procedure, our multidisciplinary team, which includes urologists, abdominal radiologists, and ultrasonographers, who all work together to achieve the best outcome, employing ventilation with anesthesia, which allows for minimal organ movement with inspiration throughout the procedure, managing the collecting system with the stent when necessary, using hydro dissection to displace adjacent structures and create a safe ablation zone, real-time monitoring with ultrasound and CT guidance, and contrasted imaging at the conclusion of the procedure, which shows residual tumor with the option for immediate treatment, if necessary.
SPEAKER 1: Percutaneous microwave ablation is an effective and safe treatment option for renal cell carcinoma in both T1a and T1b tumors in selected patients, with multiple studies showing excellent oncologic outcomes, when compared to partial and radical nephrectomy.
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You have requested to see a portion of the video outside of the clip.
Click OK to switch to the full video or click if you would like to stay inside the clip. You can always go back to the clip with Tools and Clip Mode