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Comparative Study
. 2012 Feb;79(2):484.e1-6.
doi: 10.1016/j.urology.2011.10.042. Epub 2011 Dec 20.

Are multiple cryoprobes additive or synergistic in renal cryotherapy?

Jennifer L Young  1 , David W McCormick, Surrendra B Kolla, Petros G Sountoulides, Oskar G Kaufmann, Cervando G Ortiz-Vanderdys, Victor B Huynh, Adam G Kaplan, Nick S Jain, Donald L Pick, Lorena A Andrade, Kathryn E Osann, Elspeth M McDougall, Ralph V Clayman
Affiliations
Comparative Study

Are multiple cryoprobes additive or synergistic in renal cryotherapy?

Jennifer L Young et al. Urology. 2012 Feb.

Abstract

Objective: To investigate the relationship between multiple cryoprobes was investigated to determine whether they work in an additive or synergistic fashion in an in vivo animal model because 1.47 mm (17-gauge) cryoprobes have been introduced to the armamentarium for renal cryotherapy.

Methods: Laparoscopic-guided percutaneous cryoablation was performed in both renal poles of 3 pigs using 3 IceRod cryoprobes. These 12 cryolesions were compared with 12 cryolesions using a single IceRod cryoprobe. Each cycle consisted of two 10-minute freeze cycles separated by a 5-minute thaw. The iceball volume was measured using intraoperative ultrasonography. The kidneys were harvested, and cryolesion surface area was calculated. The lesions were fixed and excised to obtain a volume measurement. Statistical analysis was used to compare the single probe results multiplied by 3 to the multiple probe group for iceball volume, cryolesion surface area, and cryolesion volume.

Results: The iceball volume for the first freeze cycle for the single cryoprobe multiplied by 3 was 8.55 cm3 compared with 9.79 cm3 for the multiple cryoprobe group (P=.44) and 10.01 cm3 versus 16.58 cm3 for the second freeze (P=.03). The cryolesion volume for the single cryoprobe multiplied by 3 was 11.29 cm3 versus 14.75 cm3 for the multiple cyroprobe group (P=.06). The gross cryolesion surface area for the single cryoprobe multiplied by 3 was 13.14 cm2 versus 13.89 cm2 for the multiple probe group (P=.52).

Conclusion: The cryolesion created by 3 simultaneously activated 1.47-mm probes appears to be larger than that of an additive effect. The lesions were significantly larger as measured by ultrasonography and nearly so (P=.06) as measured by the gross cryolesion volume.

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Figures

Figure 1
Figure 1
Freeze cycle 1 in progress, with 3 IceRods in triangular configuration 1 cm apart from each other and 1 Multipoint Thermal Sensor 1 cm peripheral to each cryoprobe.
Figure 2
Figure 2
Necroscopy of porcine kidney after cryoablation with 3 probes. Cryolesion surface area measured and calculated.
Figure 3
Figure 3
Cryolesion volume obtained by fluid displacement in graduated cylinder.
Figure 4
Figure 4
Freeze cycle initiated with single IceRod, with 1 temperature sensor placed medially and 1 peripherally.
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