Comparison of Postoperative Pain, Convalescence, and Patient Satisfaction after Laparoscopic and Percutaneous Ablation of Small Renal Masses

Abstract

Purpose: To compare the convalescence and patient satisfaction between laparoscopic and percutaneous ablation for management of small renal masses. Methods: We performed a telephone survey comparing convalescence and operative satisfaction of patients who underwent laparoscopic and percutaneous ablation between October 2000 and June 2006 at our institution. A retrospective chart review was performed to compare perioperative and postoperative convalescence parameters. Results: A total of 93 patients underwent ablation of 103 small renal masses at our institution. Laparoscopic cryoablation was performed in 58 patients, percutaneous cryoablation in 20, and percutaneous radiofrequency ablation in 15 patients. Mean patient age was 66 years (range 24–86 years), median ASA (American society of Anesthesiologists) score was 3, and mean body mass index (BMI) was 30 kg/mm². There was no significant difference in the mean age, BMI, and median ASA scores between the groups. The mean diameter of the treated mass was slightly larger in the laparoscopic ablation group (2.6 cm) compared with masses in the percutaneous cryoablation (2.2 cm, P = 0.027) and percutaneous radiofrequency ablation (2.2 cm, P = 0.042) groups. All procedures were performed under general anesthesia. Compared with laparoscopic cryoablation, percutaneous cryoablation was associated with fewer probes used per lesion (P < 0.04), shorter mean anesthesia time (P = 0.001), shorter mean hospital stay (P = 0.007), early return to nonstrenuous activity (P = 0.007), and shorter time to complete recovery (P = 0.05). Similarly, compared with laparoscopic cryoablation, percutaneous radiofrequency ablation was associated shorter mean anesthesia time (P < 0.001), early return to nonstrenuous activity (P = 0.009), early return to strenuous activity (P = 0.007), early return to strenuous activity (P = 0.04), and early return to work (P = 0.05). There was no difference in the percent of patients who had a preablation biopsy, the median opioid analgesic requirement, and patient satisfaction measured on a 0 to 5 scale between various groups. Conclusion: Our study suggests that percutaneous ablation in carefully selected patients is associated with early convalescence compared with laparoscopic ablation.