Radiology
What does this procedure involve?
The procedure involves placing an antenna (needle) through a small puncture in your skin (percutaneous approach). CT imaging is used to place the antenna accurately into the tumour. An electrode in the antenna creates microwave energy, producing heat which kills the cancer cells. A biopsy of your tumour may be taken at the same time.
What are the alternatives?
- Observation alone – leaving the tumour in your kidney and observing it carefully for any signs of enlargement.
- Open radical nephrectomy – removing the whole kidney and its surrounding tissues through an abdominal or loin incision.
- Laparoscopic radical nephrectomy – removing the whole kidney and its surrounding tissues using a telescopic (keyhole) technique; this can be performed using robotic assistance.
- Open partial nephrectomy – removing only the part of the kidney containing the tumour, through an abdominal or loin incision.
- Laparoscopic partial nephrectomy – removing only the part of the kidney containing the tumour, using a telescopic (keyhole) technique; this can be performed using robotic assistance.
- Cryoablation – freezing the tumour with cooled metal probes using CT guidance, telescopic (keyhole) techniques or direct puncture through your skin. The procedure has been requested by a consultant at the hospital who is involved in dealing with your investigations and treatment.
What happens on the day of the procedure?
You will be admitted to the Urology ward on the morning of the procedure. You will be reviewed by one of the Urology team and Anaesthetic team and may have repeat blood tests taken, if required. You will come to the Radiology (X-Ray) department in the afternoon for your procedure. The procedure will be performed by an Interventional Radiologist. They will explain the procedure to you either on the ward or in Radiology, where you will have an opportunity to ask questions and to complete a consent form.
Details of the procedure
- We normally carry out the procedure using a local anaesthetic into the skin and strong pain relief medication through a vein in your arm; occasionally we do the procedure under a general anaesthetic (i.e. with you asleep).
- We may also give you a sedative injection at the same time.
- You will be carefully monitored throughout the procedure.
- We may insert a catheter into your bladder, through your urethra (waterpipe), to monitor your urine output during the treatment; we remove this at the end of the procedure.
- We use imaging (CT scanning and sometimes ultrasound) to pinpoint the tumour in your kidney. You will have an injection of contrast through a vein in your arm for this imaging.
- We may take needle biopsy samples from the abnormal area to confirm the diagnosis of a tumour, and to assess its extent.
- he antenna is put in through the skin of your back; a tiny incision will be made to get the probe through your skin.
- The electrode in the probe creates radiofrequency energy which heats the tumour and kills the cancer cells.
- The whole procedure process takes 60 to 90 minutes to complete.
Afterwards
After the procedure you will either be taken directly to the Urology ward or spend a short time in theatre recovery – if you have had a general anaesthetic.
What can I expect when I go home?
- You usually need to stay in hospital overnight.
- You will be given advice about your recovery at home.
- You will be given a copy of your discharge summary, and a copy will also be sent to your GP.
- Any antibiotics or other tablets you may need will be arranged and dispensed from the hospital pharmacy.
- You may get some discomfort at the puncture sites which usually responds to simple pain relief.
- It is common to develop a slight fever over the first 48 hours.
- If you get a persistent temperature, which does not settle after 48 hours or increased redness or throbbing at the operation site, you should contact your GP immediately.
Are there any after-effects?
The possible after-effects and your risk of getting them are shown below. Some are self-limiting or reversible, but others are not. We have not listed very rare after-effects
(occurring in less than 1 in 250 patients) individually. The impact of these after-effects can vary a lot from patient to patient; you should ask your surgeon’s advice about the risks and their impact on you as an individual:
| After-effect | Risk |
|---|---|
| Temporary insertion of a bladder catheter | All patients |
| Bleeding requiring transfusion or embolisation (radiological blockage) | Between 1 in 10 and 1 in 50 patients. |
| Entry into your chest cavity requiring insertion of a temporary drainage tube | Between 1 in 10 and 1 in 50 patients. |
| Need for further treatment if radiofrequency is not successful in eliminating the tumour | Between 1 in 10 and 1 in 50 patients. |
| Need for re-biopsy of the area at a later stage, to see whether the tumour has been eliminated | Between 1 in 10 and 1 in 50 patients. |
| Infection or pain at the site of the skin puncture(s) | Between 1 in 10 and 1 in 50 patients. |
| Involvement or injury to nearby local structures (blood vessels, spleen, liver, lung, pancreas & bowel), requiring more extensive surgery | Between 1 in 50 and 1 in 250 patients. |
| The abnormality in your kidney may not be cancer on microscopic analysis | Between 1 in 50 and 1 in 250 patients. |
| Anaesthetic or cardiovascular problems, possibly requiring intensive care (including chest infection, pulmonary embolus, stroke, deep vein thrombosis, heart attack and death) | Between 1 in 50 and 1 in 250 patients (your anaesthetist can estimate your individual risk) |
CT scanning involves the use of ionising radiation, which can cause cell damage that may, after many years or decades turn cancerous. We are all at risk of developing cancer during our lifetime. The normal risk is that this will happen to 1 in 2 people at some point in their life.
| Type of CT scan | Typical equivalent background radiation | Additional risk of cancer | Risk level |
|---|---|---|---|
| Chest x-ray | 1 to 2 days | Fewer than 1 in 1,000,000 | Negligible |
| CT head or limb | 3 to 6 months | Fewer than 1 in 10,000 | Very low |
| UK average annual radiation dose | 1 year | Fewer than 1 in 10,000 | Very low |
| CT of whole body | 1 to 4 years | Fewer than 1 in 10,000 | Low |
Modern equipment and highly trained Radiographers will keep the exposure as low as possible.
As with all drugs and medication there is a slight risk of allergic reaction due to the injection of x-ray contrast used to enhance scans. This may vary from a rash, to, very rarely, a more severe reaction. Major life-threatening reactions are rare with severe anaphylactic reactions occurring in less than 1 in 100,000 patients (2).
Contact us
If you require further information please contact:
Helen Cowell – secretary to Dr Andrew Leitch, Interventional Radiologist
Telephone: 01642 850850, Ext: 53715
Email: [email protected]
Monday, Tuesday, Thursday, Friday – 9am until 5pm. Wednesday – 10am until 5pm
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