Cryosurgery: A review

Abstract

Cryosurgery dates back to the 19th century, with the description of the benefits of local application of cooling for conditions such as pain control. Once commercial liquefied gases became available, more progress was made in the use of cryotherapy for localized lesions. As understanding of disease response to freezing increased, safer techniques for performing freezing procedures helped prepare its clinical application in different clinical situations, such as prostate disease and bronchial cancers. Cryosurgical techniques are less invasive and have lower morbidity compared with surgical resection. However, the use of cryosurgery has been limited by a lack of good understanding of the underlying mechanisms of tissue destruction. To apply cryosurgery clinically, and to extend its use, it is important to understand the mechanisms of freeze injury on cells, and to control the thermal parameters.

Current status of spray cryotherapy for airway disease

“…The liquid was applied by direct swabbing on the skin. Cooper and Lee introduced a cryosurgical probe in 1961 which was cooled by liquid nitrogen traveling down a hollow probe (3,4). This was used to directly ablate areas in the cerebral cortex for treatment of neurologic diseases such as Parkinsonism.…”

“…In 1981, Sanderson et al also described their experience with cryoprobe ablation using bronchoscopy and a nitrogen cooled cryoprobe in a series of patients with lesions that were deemed non-surgical. The procedure had a 3% operative mortality rate (3,8).…”

“…Slower cooling such as by direct contact tends to cause mainly extracellular ice which leads to cell death by dehydration and electrolyte imbalance. SCT of liquid nitrogen on the other hand leads to very rapid cooling with intracellular ice crystallization and subsequent cell death by direct destruction of intracellular organelles (3).…”

“…Studies have shown that with SCT, there is relative sparing of the extracellular matrix in tissues (3). This matrix can then form a scaffold for subsequent tissue healing without a severe fibrotic response (18,20) and thus less longterm scarring (3,19). It has also been shown that although the matrix remains intact, SCT has an immediate softening effect on the fibrotic stricture allowing easier and wider dilation with less chance of laceration.…”

“…Extreme cooling for a therapeutic effect or cryotherapy is employed for different indications including ablation of benign and malignant neoplasms, ablation of granulation tissue, treatment of infections, nerve ablation for chronic pain, bronchoscopic biopsies, and even cosmetic surgery (1)(2)(3)(4)(5)(6). The cooling temperature can range significantly from 0 ℃ to almost -200 ℃.…”