Frequently Asked Questions

Nothing to eat or drink after midnight the day before your procedure. Only take medication by mouth which is necessary such as blood pressure or diabetes medication. No blood thinners 72 hours prior to a procedure. Patients who are taking certain medications, such as blood thinners, may be required to stop several days prior to the procedure. What to bring with you will vary for each person.

Nothing to eat or drink after midnight the day before your procedure. Only take medication by mouth which is necessary such as blood pressure or diabetes medication. No blood thinners 72 hours prior to a procedure. Patients who are taking certain medications, such as blood thinners, may be required to stop several days prior to the procedure. What to bring with you will vary for each person.

After anesthesia or conscious sedation is administered, one or more cryoprobes (slender needles) are inserted into or near the tumor. The doctor uses CT or ultrasound imaging scans to guide placement and verify that the cryoprobe tip is precisely positioned. Once each cryoprobe is in place, a cryogen (freezing agent such as Argon) is circulated inside the probe to create a very cold ice ball at the tip. The ice ball encompasses (engulfs) the entire tumor plus a safety margin beyond the tumor edges, which is verified by a CT or Ultrasound scan. Once this is accomplished, I will then warm and remove the cryoprobe(s).

Typically, after the procedure you will be taken to a recovery area where you will be monitored for a certain period of time. If your procedure requires you to stay overnight, you will be taken to your room once you can be safely moved. Otherwise, you may be allowed to go home the same day.

Most patients may resume their normal routine in a day or two dependent.

While each person is different, most patients recover quickly. Typically, patients go home the same day. Most patients make a full recovery within a week or so.

However, as with any medical procedure, there are risks, and you should always closely follow your doctor’s advice.

I will schedule a CT, MRI or Ultrasound scan shortly after the procedure either 30-90 days. Follow-up CT or ultrasound scans may also be used to monitor your progress over time.

Adrenal, bladder, bone, breast, cervix, endometrium, kidney, liver, lung, liver, lymph nodes, nerve, ovarian, pancreas, pelvic, prostate, testicular, uterine, and vaginal tumors.

Lethal ice destroys tumors with a combination of effects. Basically, freezing dries out cells and damages them beyond repair. It leaves behind harmless tissue that is absorbed by the body over time; however scar tissue inside the body will remain. Cryotherapy uses argon gas to create extremely cold temperatures to destroy diseased tissue. Tumors located below the skin surface and deep in the body, I use image-guidance to insert one or more cryoprobes, through the skin to the site of the diseased tissue or tumor and then deliver the argon gas. Living tissue, healthy or diseased, cannot withstand extremely cold conditions and will die from:

Ice formation in the fluid outside cells, which results in cellular dehydration. Ice formation within the cell. At approximately -40°C (-40°F) or less, intracellular lethal ice crystals begin to form and will destroy almost any cell.

Bursting from both swelling caused by ice expansion inside the cell or shrinking caused by water exiting the cell.

Loss of blood supply. Cells die when their blood supply is choked off by ice forming within small tumor blood vessels, causing clotting. Since the average blood-clotting time is approximately 10 minutes, the extreme cold is maintained for at least 10-15 minutes, if not longer, to assure that lethal-ice temperatures have been reached. Direct observation of the ablation temperature is possible with some apparatuses. Because cryotherapy consists of a series of steps that lead to cell death, tumors are repeatedly frozen and thawed; typically, two or more freeze-thaw cycles are used depending on the location of the tumor and size of the tumor.

Once the cells are destroyed, the white blood cells of the immune system work to clear out the dead tissue. The tumor will not completely disappear but becomes a dead tumor and/or scar.

Your physician can best answer that question, but a typical percutaneous cryoablation procedure takes about 1 1/2–2 hours.

For deeper treatments involving tumors, patients should avoid blood thinning medications for the recommended period of time before the treatment. You do not have to stop any other medications.

You should report to your doctor all medications that you are taking, including herbal supplements, and if you have any allergies, especially to local anesthetic medications, general anesthesia or to contrast materials containing iodine (sometimes referred to as “dye” or “x-ray dye”). I may advise you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or blood thinners for a specified period of time before your procedure.

Image-guided ablation of benign and metastatic tumors involving bone and metastatic soft tissue tumors may be performed with the use of general anesthesia or moderate sedation. The method of anesthesia or type of sedation must be recorded.

All patients require hemodynamic monitoring in compliance with national hospital accreditation standards and local institutional standards.

In this procedure, ultrasound or computed tomography (CT) imaging, a cryoprobe may be used. Ultrasound scanners consist of a console containing a computer and electronics, a video display screen, and a transducer that is used to do the scanning. The transducer is a small hand-held device that resembles a microphone, attached to the scanner by a cord. Some exams may use different transducers (with different capabilities) during a single exam. The transducer sends out high-frequency sound waves (that the human ear cannot hear) into the body and then listens for the returning echoes from the tissues in the body. The principles are similar to sonar used by boats and submarines. The ultrasound image is immediately visible on a video display screen that looks like a computer or television monitor. The image is created based on the amplitude (loudness), frequency (pitch), and time it takes for the ultrasound signal to return from the area within the patient that is being examined to the transducer (the device placed on the patient’s skin to send and receive the returning sound waves), as well as the type of body structure and composition of body tissue through which the sound travels.

A small amount of gel is put on the skin to allow the sound waves to travel from the transducer to the examined area within the body and then back again.

Ultrasound is an excellent modality for some areas of the body while other areas, especially air-filled lungs, are poorly suited for ultrasound.

The CT scanner is typically a large, box-like machine with a hole, or short tunnel, in the center. You will lie on a narrow examination table that slides into and out of this tunnel. Rotating around you, the x-ray tube and electronic x-ray detectors are located opposite each other in a ring, called a gantry. The computer workstation that processes the imaging information is located in a separate control room, where the technologist operates the scanner and monitors your examination in direct visual contact and usually with the ability to hear and talk to you with the use of a speaker and microphone. The traditional MRI unit is a large cylinder-shaped tube surrounded by a circular magnet. You will lie on a moveable examination table that slides into the center of the magnet. The computer workstation that processes the imaging information is located in a separate room from the scanner.

Cryotherapy to treat tissue located inside the body requires image guidance and a cryotherapy applicator or cryoprobe, a thin wand-like device with a handle or trigger, or a series of small needles. The cryoprobe is connected via tubing to a source of nitrogen or argon. Most cryotherapy units use argon gas and are approved by the U.S. Food and Drug Administration (FDA). The cryotherapy system is generally housed in the procedure room. It has a computer that can be used to control the flow of the cooling agent, which is typically stored in nearby gas tanks. Other equipment that may be used during the procedure includes an intravenous line (IV), ultrasound machine, and devices that monitor your heartbeat and blood pressure.

You will be connected to monitors that track your heart rate, blood pressure, and pulse during the procedure. A nurse or technologist will insert an intravenous (IV) line into a vein in your hand or arm so that sedative medication can be given intravenously. Moderate sedation may be used. As an alternative, you may receive general or regional anesthesia. The area where the applicators or cryoprobe are to be inserted will be shaved, sterilized, and covered with a sterile drape.

A very small skin incision is made at the site. Using imaging guidance, I will insert one or more applicators or cryoprobes through the skin to the site of the diseased tissue. Once the applicators or cryoprobe(s) are in place, the argon gas is delivered. Aside from the cryoprobe(s), nothing else enters the body. An “ice ball” is created by a rapid decrease in the temperature at the tip of the probe. This causes all water in the area around the tip of the probe to freeze. Imaging is used to guide the placement of the applicators, and monitor the freezing process. The “ice ball” can be visualized using ultrasound, CT, or MRI. Some tumors require multiple applicators to freeze completely. For prostate cancer, six to eight applicators are inserted through the perineum (the tissue between the rectum and the scrotum and penis) using ultrasound guidance.

At the end of the procedure, the applicator(s) are removed and pressure will be applied to stop any bleeding.

The opening in the skin is covered with a bandage. Typically, no sutures are needed. Your intravenous line will be removed.

The entire procedure is usually completed within one to three hours.