CRYOGENIC EQUIPMENT

Unit 5 MI

Ms.Oinam Robita Chanu 1

 INTRODUCTION
The term comes from the Greek words cryo (κρύο) ("icy
cold") and surgery (cheirourgiki – χειρουργική) meaning
"hand work" or "handiwork".

•Cryosurgery (cryotherapy) is the use of extreme cold

in surgery to destroy abnormal or diseased tissue
especially on the skin .

•Because the incidence of skin lesion is rising due to the

aging population and increasing of sun’s ultraviolet
radiation

•Cryogenic equipment is used to generate, sustain or

operate at extremely low temperatures of minus 180
degrees
Ms.Oinam Robita Chanu 2
 HISTORY OF CRYOSURGERY
o James Arnott, in 19th century, stated that a very low
temperature will arrest every inflammation which is
near enough to the surface.
o The first cryogens were liquid air and compressed
carbon dioxide snow.
o In 1961, Cooper and Lee developed the first
cryotherapy probe system, involving the circulation of
liquid nitrogen through a closed metal tube placed in
direct contact with the target tissue.

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 PROPERTY OF LIQUID NITROGEN (LN2)
oLiquid nitrogen, which boils at −195.6°C (77.4 K), is the
most effective cryogen for clinical use. It is particularly
useful in the treatment of malignant lesions.
o Temperatures of −25°C to −50°C can be achieved
within 30 seconds if a sufficient amount of liquid
nitrogen is applied by spray or probe.
o Generally, destruction of benign lesions requires
temperatures of −20°C to −30°C. Effective removal of
malignant tissue often requires temperatures of −40°C to
−50°C

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 Cryogens - Boiling point

o Liquid nitrogen (most commonly used) : -

196°C
o Nitrous oxide : - 89°C
o Solidified CO 2 (dry ice, CO 2 snow) : -78°C
o Chloro-difluoromethane : -41°C
o Dimethyl ether and propane : -24°C, -42°C
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 Mechanism of cryosurgery

o The destructive effect of freezing tissue has

been categorized into two major mechanisms
1. Immediate cell destruction
2. Delayed cell destruction

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Controlling parameters during
cryosurgery
o cooling rate
o Temperature
o Thawing rate
o Freeze duration
o Repetitive freeze- thaw cycle

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 Cooling rate
• In cryosurgery, rapid cooling rate i.e. more
than 500C/min produces intracellular ice-
crystals which is more destructive
• Such higher rates of cooling can only be
achieved
.
close to the cryo-probe

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 Temperature

• Mazur stated that the lethal temperature

range is between -50C to -500C.
• The treatment of tumor requires a tissue
temperature at which all the abnormal cells
are certainly dead.

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 Thawing rate
• Thawing rate should be slow and
continued for longer time period; rapid
thaw rates allow cell survival.

Repetitive freeze- thaw cycle

• Rapid freezing and slow thawing do not
guarantee effective cell destruction.
• Use of repeated freeze-thaw cycle is also
beneficial in treatment of cancerous tumor
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 Bio-heat Equation
oSeveral heat transfer mechanisms occur during cryosurgery, including
conduction, convection, metabolism and phase change.
o Heat transfer by conduction has been assumed to be the primary heat
transfer process during cryosurgery since the cryoprobe operates at an
extremely low temperature.
o Bio-heat transfer is the study of heat transfer in biological system.
oThe fundamental heat transfer equation in biological tissue was firstly
suggested by Pennes.

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Pennes suggested that the rate of heat transfer between blood and tissue is
proportional to the product of the volumetric perfusion rate and the difference between
the arterial blood temperature and the local tissue temperature. He expressed that
relationship as follows

Where,
hb is the rate of heat transfer per unit volume of tissue,
V is the perfusion rate per unit volume of tissue,
ρb is the density of blood,
cb is the specific heat of blood,
K is a factor that accounts for incomplete thermal equilibrium between
blood and tissue
(0<K<1, for some cases K = 0)
Ta is the temperature of arterial blood, and
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T is the local tissue temperature.
 PROCEDURE
o Warts, moles, skin tags, solar keratoses, and small skin
cancers are candidates for cryosurgical treatment.
o Several internal disorders are also treated with
cryosurgery, including liver cancer, prostate
cancer, cervical disorders and, more commonly in the
past, hemorrhoids.
o Cryosurgery works by taking advantage of the destructive
force of freezing temperatures on cells. At low
temperatures, ice crystals form inside the cells, which can
tear them apart. More damage occurs when blood
vessels supplying the diseased tissue freeze.

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o In this approach, several hollow probes (needles) are
placed in direct contact with target tissue.
o The doctor guides them into the gland(tumor) using
Trans-Rectal Ultra-Sound (TRUS).
o This type of procedure requires spinal or epidural
anesthesia (where the lower half of your body is
numbed) or general anesthesia (where you are
asleep).

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oVery cold gases are then passed through the
needles, creating ice balls that destroy the
gland(tumor).
oTo be sure the prostate is destroyed without too
much damage to nearby tissues, the doctor
carefully watches the ultrasound images during the
procedure

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oAfter the procedure, there will be some bruising and
soreness in the area where the probes were inserted.
Patients might need to stay in the hospital overnight,
but many patients leave the same day.
oThe most common method of freezing lesions is
using liquid nitrogen as the cooling solution. The super-
cooled liquid may be sprayed on the diseased tissue,
circulated through a tube called a cryoprobe.

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HOW CRYOSURGERY WORKS

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 Cryo-probe
Manufacturers have devised various metal attachments to
serve as heat-conducting probes for cryotherapy. Copper,
because of its high conductivity, is typically used.

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oThe effect of cryo-probe diameter, cryo-probe temperature and
heat generation due to metabolism and blood perfusion on phase
change heat transfer process during cryosurgery in lung tumor
has been analyzed numerically.
oResults show that
(i) increase in cryo-probe diameter
(ii) decrease in cryo-probe freezing temperature, lead to increase
in minimum temperature, freezing rate, freezing area in tissue
and decrease in tumor freezing time
oIn summary, to maximize the effectiveness of cryosurgery, it is
important to use as low a temperature as possible, cool the tissue
as rapidly as possible, Thaw as slowly as possible , use more than
one freeze thaw cycle,.

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CRYO-ABLATION
Cryo-Ablation is a process that uses
extreme cold (Cryo) temperatures to
remove tissue (Ablation).

• Cryo probes are hollow needles through

which cold, inert Argon gas is circulated.
• The probes are inserted directly into the
Tumor and the Cryogenic Freezing Unit
circulates the gas through the probes,
removing heat and killing the
surrounding tissue.
•As a result of the procedure, the tissue
undergoes Necrosis and the body clears
the tissue over time through its normal
processes.

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APPLICATION
External
•Warts
• moles
•skin tags
•solar keratoses
•Morton's neuroma

Several internal disorders such as including :

•liver cancer
• prostate cancer
• lung cancer
• oral cancers
• cervical disorders

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 Advantages of cryosurgery
1. Minimal invasion of tissue
2. Less bleeding
3. Local application
4. Less time taking
5. Anesthetic capabilities
6. Repetition of procedure
7. Minimal hospitalization
8. Less expensive

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 In summary, to maximize the effectiveness of cryosurgery, it is
important to use
1. as low a temperature as possible,
2. cool the tissue as rapidly as possible,
3. Thaw as slowly as possible
4. use more than one freeze thaw cycle,.

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