Cryosurgery: high technologies of low temperatures
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- The history of cryosurgery: how it all began?
- How does cryosurgery work?
- Cryosurgery in oncology
- The use of the method for certain types of cancer
- Benefits
- Application in other areas of medicine
- Where can I have treatment?
Cryosurgery is a method of tissue destruction using cold. It is used in many areas of medicine, such as urology, gynecology, oncology, cardiology, otolaryngology, ophthalmology, and dermatology. Treatment with cryosurgery is becoming increasingly safe and effective as equipment for this procedure improves.
The history of cryosurgery: how it all began?
Back in the middle of the 19th century, doctors tried to freeze and destroy tissue with cold, using ordinary water ice, but mixing it with salt.
In 1845, Michael Faraday made a breakthrough by mixing carbon dioxide and alcohol in a vacuum, producing a temperature of 110.15 degrees. A few years later, cold began to be used in medicine, and it was mainly used for local anesthesia and to prevent bleeding during surgery.
A method for the treatment of warts and other skin growths using compressed air was first described in 1899. It did not freeze the tissue very deeply, so it was only used in dermatology.
The era of cryosurgery close to the modern one began in 1950, when a method of freezing tissue with liquid nitrogen appeared. In 1959, needles were developed to freeze deep tissue with liquid nitrogen. Since then, methods similar to modern cryosurgery have appeared. That same year, scientists attempted to use freon to freeze tissue, but it ultimately lost out to liquid nitrogen. Back in 1959, cryosurgery was first used in oncology when doctors successfully destroyed a tumor in the brain.
In 1961, the cryoprobe appeared and began to be widely used in medicine. This year can be considered the beginning of the widespread introduction of cryosurgery into medical practice.
Cryosurgery did not become a standard technique in oncology in the 20th century, and only gained popularity among physicians in the 21st century with the advent of more advanced equipment. In 1994, the first temperature sensors were developed, making it possible to reach the target temperature in tissue. In 1995, a kidney tumor was successfully destroyed for the first time.
Cryosurgery is now one of the standard methods in oncology. It has become safer and more effective with the advent of new devices that rapidly freeze tissue with argon. The introduction of many thin probes allows the destruction of tumors of any shape and large enough size.
How does cryosurgery work?
The essence of cryosurgery is that certain tissues are destroyed by freezing and thawing them. A probe (a needle) is inserted into the area where tissue necrosis is to be induced. A cooling gas, usually argon, is passed through the probe. The temperature in the target area reaches minus 190-195 degrees. Thawing and refreezing then occurs. Thawing can be either passive or active: heating is done with another gas called helium.
Probes can be inserted through the skin, making the procedure minimally traumatic. If the tissue to be destroyed is located deep, a minor operation such as laparoscopy, thoracoscopy, or retroperitoneoscopy may be required. The doctor makes a small incision to insert the instrument into the abdomen, chest, or retroperitoneal cavity. An open approach can also be used, but is less common because of the significant trauma it can cause.
Cryosurgery in oncology
Cryosurgery cannot completely replace conventional surgery. It is one of the tissue ablation options with limited indications.
Cryosurgery is most commonly used for the following oncological diseases:
- Early-stage prostate cancer
- Early-stage kidney cancer (an alternative to partial kidney removal for patients with poor health)
- Liver metastases from colon cancer
- Hepatocellular carcinoma
Treatment with cryosurgery is considered a radical (potentially curative) method for the early stages of cancer.
When the procedure is used to suppress liver metastases, it is unlikely to cure the cancer completely, but metastatic lesions treated with cold usually do not recur.
Cryosurgery is used as a palliative method in oncology for:
- Soft tissue sarcomas
- Bone tumors and their metastatic lesions
- Pancreatic cancer
- Lung cancer
Eliminating pain and other symptoms by reducing the tumor mass is the main goal of treatment in this situation.
The use of the method for certain types of cancer
Here are some features of the use of cryosurgery for some malignant neoplasms:
Kidney cancer. The technique is used mainly for tumors up to 4 cm in size, as an alternative to partial kidney removal. Surgery is considered the main treatment method, and cryosurgery is used when there are contraindications. It provides comparable survival rates. In more than 90% of patients, the tumor does not recur. In patients with one kidney or damage to both kidneys, the technique can also be used for neoplasms at advanced stages.
Prostate cancer. Cryosurgery is used for localized cancer, in patients from low and intermediate risk groups when the prostate volume does not exceed 40 ml. It is recommended in case of contraindications or refusal of the patient to surgery and radiation therapy. A probe to destroy the tumor is inserted into the prostate through the rectum. Cryodestruction is a potentially curative method for prostate cancer treatment.
Malignant liver tumors. They can be primary or metastatic. These tumors are often multiple, and many patients suffer from liver cirrhosis, have a low functional reserve, and are not considered candidates for surgical treatment. In such a situation, cryosurgery is one of the options for long-term tumor control. Percutaneously or during surgery, doctors insert cryoprobes into the centers of tumors and freeze them. The technique provides a five-year survival rate of up to 44% for patients with metastatic liver damage, and up to 22.2% for primary liver cancer (hepatocellular carcinoma), which is an excellent result for this aggressive tumor.
Pancreatic cancer. Only a small number of patients can be treated surgically. Cryosurgical destruction of the tumor helps relieve pain and in some cases can improve survival rates.
Benefits
The main benefit of cryosurgery over conventional surgery is its lower trauma rate. It is much lower than that of surgery, even when a laparoscopic approach is required to insert cryoprobes. In this case, the hospital stay does not exceed 1-2 days. If cryosurgery is performed without incisions, by inserting the probe percutaneously, it becomes a one-day procedure that is performed without hospitalization.
Other benefits are as follows:
- Cryosurgery can be used in the presence of contraindications to conventional surgery: in patients with poor health
- It is less likely to cause complications and does not require long-term rehabilitation
- The cost of treatment is lower compared to surgery
- Tumors located in the area of major blood vessels can be treated: portal vein and mesenteric veins, celiac trunk, common hepatic, splenic, and superior mesenteric arteries
Application in other areas of medicine
In addition to oncology, cryosurgery is most often used in the following areas of medicine:
Cardiology, cardiac surgery, and arrhythmology. Cryoablation is used as a safer alternative to radiofrequency ablation in patients at a high risk of complete atrioventricular block. It is most commonly used in the treatment of atrial fibrillation, less commonly for other diseases such as Brugada syndrome, ventricular tachyarrhythmias, and hypertrophic cardiomyopathy (congenital abnormal thickening of the myocardium).
Urology. This is one of the most common areas of application of cryosurgery. In addition to prostate and kidney malignancies, it is also used to remove benign tumors. Retrograde ejaculation can be treated with selective cryoablation of penile nerves.
Gynecology. Cryosurgery can be used for the destruction of polyps in the uterus and cervical canal in cases of grade 1 cervical intraepithelial neoplasia.
Dermatology. Historically, this is the first area of application of cryosurgery. This method is used to remove warts, papillomas, nevi, hemangiomas, and other neoplasms.
Ophthalmology. Cryosurgery is used to remove pigmented, vascular, and other abnormal neoplasms of the sclera, eyelids, conjunctiva, and cornea. The technique is safe for health because the outer shells of the eye and the vitreous body are highly resistant to low temperatures.
Where can I have treatment?
You can have treatment in Germany. Leading German hospitals use modern types of cryosurgery to perform this procedure:
- With minimally invasive techniques
- Quickly
- Without any health risks
- With excellent treatment results
- With a short rehabilitation period
You can find out the cost of treatment on the Booking Health website. You can compare prices for medical services in different German hospitals and choose the right option to be treated there. If you need a consultation with a medical tourism specialist, please leave your request on the Booking Health website. They will help you choose a hospital, make an appointment for your preferred dates, and organize your trip to Germany. When you make your appointment through Booking Health, the cost of treatment will be lower than when you contact the hospital directly, as there are no additional fees for foreign patients.
Choose treatment abroad and you will be sure to get the best results!
Authors:
This article was edited by medical experts, board-certified doctors Dr. Nadezhda Ivanisova, and Dr. Vadim Zhiliuk. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
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