OBJECTIVE To test and establish clinical proof of concept for a laparoscopic high-intensity focused ultrasound (HIFU) device that facilitates delivery of ultrasound by direct application of a probe to the tumour surface. PATIENTS AND METHODS Twelve patients with renal tumours were treated with laparoscopic HIFU using a newly designed probe inserted via an 18-mm laparoscopic port. HIFU treatment was targeted at a pre-defined proportion of the tumour and immediate laparoscopic partial or radical nephrectomy was then performed. RESULTS No tumour ablation was seen in the first five patients which made modifications in the treatment protocol necessary. After this, definite histological evidence of ablation was seen in the remaining seven patients. The ablated zones were within the targeted area in all patients and no intra-lesional skipping was seen. Subcapsular skipping was seen at the probe-tumour interface in two patients with viable tumour cells seen at microscopy. One patient did not undergo surgical extirpation; subsequent biopsy revealed no viable tumour cells. There were no intraoperative or postoperative complications directly related to HIFU therapy and patients have reached a mean (range) follow-up of 15 (8-24) months with no evidence of metastatic disease or late complications. CONCLUSIONS Tumour ablation with laparoscopic HIFU is feasible. Homogenous ablation can be achieved with no vital tissue within the targeted zone. The technique is associated with low morbidity and may have a role in the definitive management of small tumours.
- high-intensity focused ultrasound
- kidney neoplasms
- minimally invasive therapy
- renal cancer
ASJC Scopus subject areas