Advanced bronchoscopic procedures
Don Hayes, Kara D. Meister in Pediatric Bronchoscopy for Clinicians, 2023
Cryotherapy may be used to ablate tissue, retrieve tissue and foreign bodies, and perform biopsies. Cryoadhesion involves directly contacting the target object, essentially freezing the tissue or foreign body to the end of the probe and allowing it to be pulled back partially or completely with the probe. Foreign bodies must have some water content in order to be removed with a cryoprobe. In the authors' experience, this method is also helpful for removal of large clots from the airway in the case of pulmonary or airway hemorrhage. Cryospray, in contrast, involves spraying the cooling substance or cryogen (usually a pressurized gas that causes rapid cooling as it exits the delivery device and expands) topically onto the target tissue, causing tissue damage and eventual necrosis and ablation.
Hepatocellular Carcinoma
Pat Price, Karol Sikora in Treatment of Cancer, 2020
Image-guided ablation is regarded as the best therapeutic option for patients with small HCC not suitable for resection or transplantation. Treatment is usually performed percutaneously under ultrasound or CT guidance. Several methods for tumor destruction have been used, the most widely studied being percutaneous ethanol injection (PEI) and radiofrequency ablation (RFA). The injection of 90 per cent ethanol under ultrasound guidance is technically straightforward, inexpensive, safe, and results in 5-year survival of 50 per cent in Child A, 30 per cent in Child B, but less than 10 per cent in Child C cirrhotics.49 Complete tumor necrosis is achieved in 70 per cent of tumors less than 3 cm in diameter, but this falls with increasing size (50 per cent in lesions 3–5 cm), probably due to the inability of the injected volume to disperse evenly throughout larger tumors that may contain fibrous septae. Radiofrequency ablation is a localized thermal treatment producing tumor destruction by heating a probe inserted into the tumor to temperatures exceeding 50°C, which can be performed percutaneously under image guidance, laparoscopically or at laparotomy.
Pregnancy
T. Yee Khong, Annie N. Y. Cheung, Wenxin Zheng, Richard Wing-Cheuk Wong, Hao Chen in Diagnostic Endometrial Pathology, 2019
Endometrial ablation has become a well-established alternative to medical treatment or hysterectomy to treat abnormal uterine bleeding. The rationale is to replicate Asherman's syndrome so that there is little or no endometrium remaining. Placenta accreta is not an invariant accompaniment in pregnancies following endometrial resection.24,25 Endometrial ablation, by necessity, will cause damage to the superficial portions of the endometrial vessels but will also likely cause scarring to the endometrial interstitium and the superficial myometrial layer, all of which are anatomically involved in the development of the maternal response to pregnancy. Thus, it is not surprising that case reports of subsequent pregnancies frequently describe fetal growth restriction and intrauterine fetal demise.25
Contrast-enhanced ultrasound is a reliable and reproducible assessment of necrotic ablated volume after radiofrequency ablation for benign thyroid nodules: a retrospective study
Published in International Journal of Hyperthermia, 2022
Lin Yan, XinYang Li, Jing Xiao, YingYing Li, Yaqiong Zhu, Hongying He, Yukun Luo
As minimally invasive treatments, the primary purpose of ablation was the resolution of cosmetic problems and nodule-related symptoms rather than complete treatment [19]. After ablation, the total volume (Vt) of nodule was divided into ablated volume (Va) and vital volume (Vv) [20,21]. Recently, some novel parameters have emerged using Va for calculation to evaluate the efficacy of ablation. Vv increase, which defined as a more than 50% increase compared to the previously reported smallest Vv, was found to be not only an early sign of nodule regrowth [20,22], but also an indication of additional ablation [23]. Moreover, a quantitative index, the initial ablation ratio (IAR) calculated by the ratio of Va to Vt at the first follow-up period, was developed to predict the therapeutic success after RFA [24,25]. All these parameters needed Va for calculation, which was measured on conventional ultrasound (US) based on a decreased hypoechoic zone without vascularity in the treated nodule [20,24,25]. However, the boundary between the ablated and vital zone was not easily differentiated on conventional US, making Va measurement potentially inaccurate [26,27].
Focal therapy for localized cancer: a patent review
Published in Expert Review of Medical Devices, 2021
Jette Bloemberg, Luigi Van Riel, Dimitra Dodou, Paul Breedveld
Habib [178] describes a flexible catheter containing multiple electrodes for thermal ablation of a blood vessel supplying a tumor using radiofrequency current (Figure 4(a)). The catheter is mounted on a guidewire, and the distal tip comprises extendable elements that can be deployed outwards from the shaft to contact the hollow vessel wall. Temperature sensors at the catheter tip allow for intra-procedural monitoring. Similar patents on instruments applying a heated lumen around the vessel [179] or inserting a catheter with a thermal probe inside a vessel [180] have been found. Another design variation comprises an ablating implant inserted in the blood vessel [75,181]. Besides thermal ablation, cryoablation is also able to cause vascular injury (as well as direct cell destruction, making cryoablation a hybrid method, see Section 3.1.1), leading to cell death [5]. A number of instruments have been proposed that induce cryoablation of blood vessels by removing thermal energy [32–34,36,37].
Hysteroscopic removal of a gauze inadvertently retained in uterus for two years following caesarean section
Published in Journal of Obstetrics and Gynaecology, 2021
Silvia Amodeo, Nicoletta Di Simone, Vito Chiantera, Giovanni Scambia, Valeria Masciullo
The next day, we performed the elective procedure under general anaesthesia using a monopolar Iglesias 9 mm resectoscope with a 90° loop and a zero-degree optic (Karl Storz, Tuttlingen, Germany). We used a solution of 5% glycine to stretch uterine cavity and an automatic pressure infusor (Endomat, Karl Storz, Tuttlingen, Germany) to provide positive pressure (110 mm Hg). Blood clots and debris covered the gauze and the endometrium surrounding the gauze was diffusely necrotic (Figure 1(A)). Therefore, we started by cutting off the peripheral side of the gauze with a loop electrode to improve endoscopic vision and subsequently allow the mobilisation of the gauze (Figure 1(B)). Luckily, the stitches of the suture did not trap the gauze. However, in order to avoid uterine inversion, one of the extremities of the gauze was pulled out in the vagina and kept in tension, while the surgeon dissected with the angular loop the granulation tissue entrapping the gauze at the uterine wall. The removal of the strongly smelling gauze was followed by plentiful discharge of purulent material. We also performed endometrial ablation. The patient was discharged the same day with antibiotic therapy (cephalosporin) for the following 15 d. At histological examination, the foreign body was a square surgical gauze, partly macerated, with radiopaque thread and size of 35 × 30 mm. Endometrial biopsies showed granulation tissue with foreign-body giant cell reaction. The patient’s symptoms improved in the next two weeks until complete resolution.
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