Cryosurgery is usually used for skin tumors. However, some internal tumors can be treated this way as well. The surgery involves the use of. Cryosurgery is the use of extreme cold in surgery to destroy abnormal or diseased tissue; thus, it is the surgical application of cryoablation. The term comes from. A fact sheet that describes cryosurgery, the technique of using extreme cold to treat tumors. Lists the indications, risks, benefits, and side effects of cryotherapy.
The doctor will apply frozen nitrogen using either a cotton swab or a spray device. The goal is to freeze the skin quickly and then allow it to slowly thaw to cause maximum destruction to targeted skin cells. In some cases, additional applications may be needed. When treating skin cancer, the doctor may insert a small needle containing a thermometer into the treatment area to ensure the treated area has been sufficiently cooled.
Careful consideration is give to skin cancers to make sure they have no spread beyond the superficial layer of the skin. No extensive preparation is necessary for cryosurgery. The treatment area must be clean and dry, but it is not necessary to be sterile. Cryosurgery can be used to treat age spots , skin growths warts and skins tags and early stage basal and squamous cell carcinomas. Patients may experience a mild burning sensation during treatment. Local anesthesia usually is not required.
Redness, swelling and the formation of a blister can be expected at the treatment site. An over-the-counter pain reliever can be used to control pain. Patients will be directed to wash the site daily while fluid continues to ooze from the wound, usually for five to 14 days, until a dry crust forms. Even today the containers used for refrigerants have much the same design.
Allington is generally thought to have been first to use liquid nitrogen, in He recognized that the properties of liquid nitrogen were very similar to those of liquid air and oxygen. After the Second World War, liquid nitrogen became freely available and was preferable to liquid oxygen with its explosive potential. He used a cotton swab for treating various benign lesions but poor heat transfer between swab and skin meant this method was insufficient for tumour treatment. The contribution of Dr Irving S Cooper to cryosurgery was immense 18 , With it he treated Parkinson's disease and other movement disorders by freezing the thalamus, in addition to previously inoperable brain tumours.
Although Cooper was controversial in his lifetime because of his showmanship, his work led to an explosion of interest in liquid nitrogen and its eventual acceptance as a standard treatment in many specialties.
More general use of cryosurgery was facilitated by the development of devices suitable for office based practice. Torre 20 developed a liquid nitrogen spray in and Zacarian a hand-held device, the Kryospray, in Zacarian popularized the use of this equipment Zacarian's spray allowed one-handed operation with trigger type control, and interchangeable tips permitted variations in spray diameter.
Zacarian also developed copper probes that allowed tissue-freezing to depths of up to 7 mm. His contributions to cryosurgery equipment, understanding of the science of the cryolesion and the published work on cryosurgery was very great. Amoils 22 developed a liquid nitrogen probe that achieved cooling by expansion. He performed cataract extraction cryoextraction successfully but cooling was slow and temperatures were not low enough for tumour work. This system is still widely used in gynaecology and ophthalmology.
The use of liquid nitrogen spread through different specialties Rand performed a transphenoidal hypophysectomy with liquid nitrogen, Gage treated oral cancers and Cahan performed cryosurgery of the uterus with a liquid nitrogen probe.
The use of liquid nitrogen in Great Britain took off when Zacarian donated the first hand-held liquid nitrogen spray to the Oxford dermatology department in the s. This centre became the focus of cryosurgical research in Britain. The past 50 years have seen great advances in knowledge of the biological effects of freezing. Almost all research has concerned the effects of liquid nitrogen. The development of temperature probes that can be inserted into skin has allowed measurement of tissue temperatures during freezing.
An accurate picture of the shape and depth of iceball formation with different lengths of freeze has been built up, allowing development of guidelines for freezing times best established for cutaneous lesions For malignant lesions freezing times are longer than for benign lesions since destruction of all malignant cells is vital.
Other research has concentrated on determining the sensitivity of individual cell types to freezing. Melanocytes are most sensitive, hence the depigmentation of skin often seen after cutaneous cryosurgery. Collagen is the most resilient tissue, and indeed preservation of the normal structure of collagen bundles is observed on electron microscopy even after the deep freezes necessary for tumour work.
This explains why there is so little scarring Cartilage necrosis is extremely rare, so cryosurgery is particularly suitable in areas where maintenance of elasticity and function are important—such as the ear, around the eyes and the nose Liquid nitrogen is by far the most popular cryogen in current use.
Its effects are predictable and well documented. Carbon dioxide still enjoys some popularity because of its easy storage but is really only suitable for the occasional user and for treatment of benign lesions.
Nitrous oxide is favoured by many gynaecologists and oral surgeons. Storage presents no problems but the large cylinders required are not easily portable. Only a probe method is suitable because spraying results in formation of solid crystals of nitrous oxide. Freons fluorinated hydrocarbons with a low boiling point have been used in dermatological practice since when Wilson advocated their use for firming skin before dermabrasion Freon 12 has been used for acne pits and is especially useful when a large surface area needs to be treated.
The major advantages of freons are their portability and easy storage but their disadvantages are insufficiently low temperatures for tumour work, potential toxicity in inhaled air and their role in depleting the ozone layer.
Currently a spray-on non-fluorinated hydrocarbon can be prescribed the Histofreezer, Thames Laboratories UK but this is unlikely to achieve temperatures low enough to be highly effective. Cryosurgery is now indispensable in a dermatology department. Benign lesions amenable to treatment include viral warts, seborrhoeic keratoses, molluscum contagiosum, spider angiomata and digital myxoid cysts However, when cryosurgery is contemplated for benign lesions it is especially important to consider the possible side-effects of pain, blistering and hypopigmentation.
Cryosurgery is highly effective for premalignant solar keratoses and Bowen's disease. Cure rates after cryosurgery of Bowen's disease are comparable with those of excision, curettage and cautery Basal cell carcinomas are commonly treated by cryosurgery and the cure rates also compare very favourably with those of surgical treatments, in carefully selected patients.
Other tumours that can be effectively treated are squamous cell carcinomas and lentigo maligna Many other specialties have embraced and refined the technique of cryosurgery. Eye surgeons have used it extensively. The first report of retinal tears treated by freezing came from Bietti 30 in , and when Bellowes reviewed cryotherapy of ocular diseases in he included cryoextraction of cataracts and treatments for glaucoma and tumours Cryosurgery still has an important place in modern ophthalmological practice, particularly for eyelash ablation in trichiasis 31 , treatment of retinopathy of prematurity 32 and retinal detachment.
In gynaecology the use of cold treatment goes back as far as , when Openchowski 13 treated chronic cervicitis with cold water irrigation. Temple Fay 33 , in Philadelphia, applied both local and general cold treatment for cervical tumours during the s and in Cahan 34 developed the liquid nitrogen probe for the treatment of uterine fibroids and cervical neoplasia. There has been some interest in cryosurgical treatment of cervical intraepithelial neoplasia but this is losing favour.
Cryosurgery of vulval intraepithelial neoplasia is followed by early recurrence and is not to be recommended Palliation of surgically unresectable vulval squamous cell tumours can be very beneficial, with reduction of pain and tumour size General surgeons have used freezing as an adjunct to surgery. Allen 37 , in , recognized that limbs packed in ice for 3 hours could be subsequently amputated without an anaesthetic agent, and as recently as a review article 37 described the use of freezing to delay an otherwise urgent amputation and allow more time for stabilization of a critically ill patient.
Patients selected were unable to undergo surgical treatment either because of prohibitive operative risk or because of unresectable tumour. Cryosurgery has been shown to be an effective treatment for haemorrhoids 39 and may be a useful alternative to surgical haemorrhoidectomy in countries where health resources are limited. Other areas of current interest include a nephronsparing treatment option for kidney cancers 41 and cryosurgical treatment of prostatic cancer In prostate cancer, impotence and incontinence are less frequent with cryosurgery than with radical prostatectomy or radiotherapy.
Further studies will be necessary to assess longterm cure rates. Hepatic cryosurgery for either metastatic carcinoma or primary hepatocellular carcinoma, via cryoprobe, gives results similar to those of surgical resection.
The major advantage is the ability to treat widespread lesions, whereas surgical resection is limited to isolated or small foci of tumour Also, cryosurgery has been used for bone tumours for 30 years and still has a role After nearly two centuries, the technique of cryotherapy remains widely applicable.
At a time when surgical excision is in the ascendant this simple method, with its cosmetic and functional benefits, should not be neglected. National Center for Biotechnology Information , U. J R Soc Med. Author information Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Open in a separate window. A man self-administering hydrotherapy.
James Arnott, MD Aberdeen , , a pioneer in refrigeration. Ann Chemie Physique ; Am Chemie Physique ; Med Rec ; Possibilities of liquid air to the physician. Liquid air in dermatology: Liquid air in dermatology. Med Surg J ; The use of carbon dioxide snow in the treatment of naevi and other lesions of the skin. The therapeutic effects of carbon dioxide snow: Simpkin, Marshall, Hamilton, Kent, The historic development of cryosurgery.
Clin Dermatol ; 8: Liquid air and carbonic acid snow: NY Med J ; Irvine H, Turnacliffe D. Liquid oxygen in dermatology. Arch Dermatol Syphilol ; Arch Dermatol ; Liquid nitrogen in the treatment of skin diseases. Calif Med ; A new method of destruction or extirpation of benign or malignant tissues. N Engl J Med ;
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A cryoprobe is cooled with substances such as liquid nitrogen, liquid nitrous oxide, or compressed argon gas. Cryosurgery may be used to treat certain types of. Cryotherapy is also called cryosurgery or cryoablation. It's when doctors use freezing cold temperatures to kill abnormal cells or small tumors. cryosurgery is a procedure usually performed in your doctor's office. she will use a spray, cotton swab, or metal device called a cryoprobe to apply extremely cold .