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History of Minimally Invasive Cardiac Surgery
Published in Theo Kofidis, Minimally Invasive Cardiac Surgery, 2021
Energy modalities used for Cox Maze IV include radiofrequency, cryoablation, high-intensity focused ultrasound, microwave (pioneered by Pruitt JC) and laser. The last two have fallen out of favor as studies have demonstrated that they are not as efficacious and are unable to reliably produce transmural scarring on a beating heart [12–14]. Radiofrequency uses alternating currents to emit electromagnetic energy and heat deeper layers of tissues by conduction to cause transmural myocardial scarring. Randall Wolf developed the bipolar RF clamp and performed the Maze procedure via small non-rib spreading incisions, which was named the Wolf mini-Maze procedure. Cryoablation uses rapid cooling of the probe to cause cell death by freezing and results in a full-thickness scar. Charles Mack was one of the first surgeons who reported his results of argon-based cryoablation using a novel argon-based clamp [15] for atrial fibrillation. High-intensity focused ultrasound (Epicor – first used by Michael Harostock) generates thermal energy by using ultrasound waves to harmonically oscillate water molecules (Figure 2.12 and Figure 2.13).
Current Role of Focal Therapy for Prostate Cancer
Published in Ayman El-Baz, Gyan Pareek, Jasjit S. Suri, Prostate Cancer Imaging, 2018
H. Abraham Chiang, George E. Haleblian
Overall, cryoablation appears to be a well-tolerated procedure with a relatively low sexual and genitourinary adverse side effect profile when compared to radical therapies. However, randomized controlled trials comparing cryoablation to standard of care therapies are needed to better assess oncologic and functional outcomes.
Prostate Cancer
Published in Anthony R. Mundy, John M. Fitzpatrick, David E. Neal, Nicholas J. R. George, The Scientific Basis of Urology, 2010
Freddie C. Hamdy, Craig N. Robson
The in situ destruction of tumors by the application of low temperatures was first developed in the 1970s to treat localized prostate cancer with reasonable success. Cryoablation had a number of advantages over other forms of treatment, but suffered from many limitations. Equipment was cumbersome, probes were placed mostly transurethrally under digital rectal guidance, temperature control was poor, and damage to adjacent tissue was common. The ability of real-time TRUS to guide cryoprobe placement and accurately monitor the freezing process, in addition to the development of urethral warming devices, encouraged clinicians to attempt again the destruction of prostate cancer by freezing. A number of studies on humans followed the animal work, and results are slowly emerging (61, 62).
Periprocedural factors associated with overall patient survival following percutaneous image-guided liver tumor cryoablation
Published in International Journal of Hyperthermia, 2022
Dania Daye, Emmy Y. Hu, Daniel I. Glazer, Kemal Tuncali, Vincent Levesque, Paul B. Shyn
All cryoablations were performed by one of three radiologists with between 1 and 16 years of experience with cryoablation over the course of the study. Procedures were performed with Visual Ice, Galil Medical Inc (Arden Hills, MN) and 17- or 14-gauge applicators. The mean applicator gauge and density (defined as number of applicators/maximum tumor diameter in cm) were 15.8 ± 2.2 and 1.7 ± 1.1. Applicators were insulated in almost all procedures (92%). The standard cryoablation procedure protocol used two 15-min freeze cycles separated by a 10-min thaw. An anesthesiologist assisted all ablation procedures, using either general anesthesia (n = 111) or monitored anesthesia (n = 32). Seventy-three patients underwent ablations performed under CT-guidance, 63 under MRI-guidance and 7 under PET/CT-guidance. CT-guided procedures used one of three scanners: CT scanner portion of Biograph mCT PET/CT scanner (Siemens, Erlangen, Germany), Somatom Sensation (Siemens, Erlangen, Germany), or Definition AS (Siemens, Erlangen, Germany). MRI-guided procedures used a 70 cm, wide bore Magnetom Verio 3 Tesla MR scanner platform (Siemens, Erlangen, Germany). PET/CT-guided procedures used a Biograph mCT (Siemens, Erlangen, Germany) with CT-fluoroscopy capability and 21 cm z-axis field of view (PET) for guidance.
Non-pharmacological treatments for chronic orchialgia: A systemic review
Published in Arab Journal of Urology, 2021
Kareim Khalafalla, Mohamed Arafa, Haitham Elbardisi, Ahmad Majzoub
Cryoablation is a treatment modality that utilises low temperatures to obliterate nerve fibres thereby blocking pain sensation. It has been utilised for a long time particularly for nerve entrapments [47]. In the setting of CO, cryoablation has been investigated in a single study by Calixte et al. [35] particularly for patients with persistent pain following MSCD. The authors speculate that failure of pain relief in this subset of patients may be due the presence of residual nerves medial and lateral to the spermatic cord at the level of the external ring. As such, the authors performed US-guided cryoablation o 221 patients by inserting the cryoprobe medial and lateral to the spermatic cord at the external ring. Argon gas was used to achieve a temperature of – 106.7°C (–160 °F) at the probe tip. Two freezing cycles of 90 s each were performed with passive thawing until a 1.5-cm ice ball was visualised through real-time US on either side of the spermatic cord. Patients were followed with a VAS pain score and the Pain Impact Questionnaire-6 (PIQ-6). The authors reported 75% pain reduction with the VAS following the procedure (11% complete resolution and 64% ≥50% reduction in pain). The results of the PIQ-6 questionnaire further confirmed that a favourable response can be achieved for a prolonged period, as 64% had a significant reduction of pain 5 years after the intervention (P < 0.001). The side effects were minimal and included wound infection in two patients and penile pain in four.
Cryoablation versus antiarrhythmic therapy for initial treatment of atrial fibrillation: a systematic review and meta-analysis
Published in Expert Review of Cardiovascular Therapy, 2021
Mitra Patel, Khalid Changal, Neha Patel, Ahmed Elzanaty
Maintaining sinus rhythm limits the progressive effect of AF on anatomical and pathophysiological changes in the heart [12]. It has recently been established that early rhythm control in patients with AF reduces the risk for future cardiovascular and neurovascular events [4]. The limiting factor to the initial use of cryoablation is the evaluation of safety. The most common procedural adverse event was self-limited phrenic nerve palsy which occurred in a total of four patients. The Medical Antiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation (MANTRA-PAF) trial observed cases of death when using radiofrequency ablation as an initial treatment of AF, which questions its use as an initial therapy [13]. Our meta-analysis observed no cases of death or any disabling adverse events, but rather patient surveys showed a better quality of life at 12 months in patients who received cryoablation.