Alternative Modes of Tissue Coagulation and Removal
Sujoy K. Guba in Bioengineering in Reproductive Medicine, 2020
Cryosurgery for cervical erosion is an outpatient procedure requiring no anesthesia. In fact the pain is less than with electrocautery. Intravenous diazepam or a para cervical block may be given in apprehensive patients. In use the cryoprobe is applied to the cervix with the cone fitting the cervical os and the refrigerant is passed through the probe for cooling.Within 15 seconds the surface film of moisture freezes, fixating the probe to the os. Without applying traction the cooling is continued for several minutes, the duration depending upon the depth of effect desired. Thereafter the cooling system is turned off. Some equipment have a rewarming facility which is then turned on and the adhesion between the probe can be removed. In the absence of this provision of rewarming one has to wait for natural thawing which may take about a minute and during this period no pull is exerted on the os.
Techniques
Richard P. Usatine, Daniel L. Stulberg, Graham B. Colver in Cutaneous Cryosurgery, 2014
The treatment of the following lesions may benefit from the cryoprobe most (see Chapter 8 for more details on the treatment of all these benign lesions): AngiofibromasAngiomas (cherry and spider)Digital mucus cysts (Figure 5.19)Hemangiomas (Figure 5.20)LymphangiomasMucocelesPyogenic granulomasVenous lakes.
Model of skin tissue heat transfer in the conditions of cryosurgical impact
Waldemar Wójcik, Sergii Pavlov, Maksat Kalimoldayev in Information Technology in Medical Diagnostics II, 2019
One of the promising methods of creating the localised necrotising damage in tumor tissue is cryoablation (cryosurgery, cryotherapy). However, in spite of the advanced construction of the modern cryoprobes, the accuracy of their temperature impact on the tissue is not sufficient. For impact that is more efficient, it is necessary to know the tissue degradation mechanism when cryosurgery methods are applied, be able to evaluate the degree of cold damage to the tissue and its thermal history in case of an influence of cryogenic factors. The efficiency of tumor cells destruction in situ depends on the parameters of cold impact and peculiarities of the tissue (geometry of the cryoprobes, the distance between them, heat conduction and hydration state of the tissue, its chemical and morphological composition). The method restrictions are connected with the heat sink effect from the neighbouring blood vessels. That is why during the procedure the size of the ablation area and the corresponding diameter of cryonecrosis can vary for different types and layers of the tissues (Alexiades & Solomon 1993, Andersen et al. 2000, Cattaneo 1958, Chen & Holmes 1980, Duck 1990, Durkee et al. 1990, Durkee et al. 1991, Gustrau & Bahr 2002, Hodson et al. 1989, Jiji 2009). The minimally invasive character of the cryoablation complicates the control over the procedure. Expansion of the cold during the procedure occurs outwards rather than in the depth of the tissue from the point of freezing, therefore the degree of the tissue subjected to freezing is not determined visually. Besides, nonselective freezing does not always lead to the complete destruction of the tissue.
Hysteroscopic treatment of submucosal fibroids in perimenopausal women: when, why, and how?
Published in Climacteric, 2020
S. G. Vitale, G. Riemma, M. Ciebiera, S. Cianci
According to the FIGO classification, the complete excision of fibroids using the slicing technique provided with a resectoscope or, in the case of smaller fibroids, in-office mini-resectoscope is the most commonly used approach for types 0 and 126,36. The slicing technique consists of a repeated and progressive passage of the cutting loop, and allows the operator to split the submucosal fibroid into smaller fragments, which can flow outside the uterine cavity. The procedure is considered finished by the operator when the fasciculate fibers of the myometrium are visualized. In the case of larger type 1 fibroids (at least 3 cm in diameter), the operator should proceed more carefully since there is an increased risk for intraoperative complications (fluid intravasation syndrome, postoperative pain, major bleeding). Besides, the use of electrosurgery may bring more damage to the surrounding myometrium10,12,26,41. Some authors are using a new technique with a cryoprobe to remove parts of the resected tissues, so the risk of complications may be reduced and visualization improved42.
A review on the efficacy and safety of iodine-125 seed implantation in unresectable pancreatic cancers
Published in International Journal of Radiation Biology, 2020
Sheng-Nan Jia, Fu-Xing Wen, Ting-Ting Gong, Xin Li, Hui-Jie Wang, Ya-Min Sun, Ze-Cheng Yang
Cryosurgery/cryoablation is one of the techniques in which a very low temperature is employed to induce the killing of cancer cells (He et al. 2017). However, the major limitation of this therapy is that all cells are not destroyed, particularly in the border zone, where temperature is more than −20 °C. These scientists attempted to complement the cryosurgery with 125I seed implantation for the treatment of pancreatic cancer. In 49 patients, the combination was shown to increase the median survival duration to 16.2 months. In these patients, the 6-, 12-, 24- and 36-month survival rates were 94.9%, 63.1%, 22.8% and 9.5%, respectively (Xu et al. 2013a). Another study has shown the efficacy of the combination of cryosurgery and 125I seed implantation in the treatment of stage IV pancreatic cancer (Chen et al. 2012).
Cryoablation: physical and molecular basis with putative immunological consequences
Published in International Journal of Hyperthermia, 2019
John G. Baust, Kristi K. Snyder, Kimberly L. Santucci, Anthony T. Robilotto, Robert G. Van Buskirk, John M. Baust
The freezing process is initiated by the activation of one or more cryoprobes appropriately placed to treat a tissue mass of certain geometry often with intraoperative ultrasound visualization. CT and MRI guidance can also be utilized. Probe positioning is accomplished, when possible, to assure that the −40°C isotherm reaches the tumor margin. After the planned freeze volume is attained, the cryogen flow is terminated and the frozen mass of tissue is allowed to thaw passively. Slow thawing is more damaging than a rapid thaw [16]. Many cryoprobes have heating capability which may serve one of two functions. The first and most common is to loosen the cryoprobes from the frozen mass to end the procedure. The second supports the repositioning of the probes. Using the heat function to assist or speed tumor thawing may be counterproductive as tissue adjacent to the cryoprobe has already received the maximal destructive consequences of the highest freeze rate. Further, active probe heating will not significantly affect the tumor margin where tumor cell survival may be possible due to limited freezing. Thawing of the freeze zone periphery is accomplished by heat flux from surrounding tissue.
Related Knowledge Centers
- Surgery
- Cryoablation
- Wart
- Nevus
- Skin Tag
- Actinic Keratosis
- Molluscum Contagiosum
- Morton'S Neuroma
- Skin Cancer
- Internal Medicine