The Perfect Per Cryo Probe For Any Procedure

PERC-24

PERC-24L

ICEBALL 37 57

-20 C ISOTHERM 28 48 -40 C ISOTHERM

ICEBALL 37 57

-20 C ISOTHERM 28 48 -40 C ISOTHERM

Diameter Shaft Length

2.4mm 23cm

DIAMETER LENGTH (MM) (MM)

37 28 19

ICEBALL

-20 C ISOTHERM

-40 C ISOTHERM

DIAMETER LENGTH (MM) (MM)

37 28 19

PERC-17

Diameter 1.7mm Shaft Length 15cm

DIAMETER LENGTH (MM) (MM)

ICEBALL 33 54

-20 C ISOTHERM 21 42 -40 C ISOTHERM 14 35

DIAMETER LENGTH (MM) (MM)

ICEBALL 33 54

-20 C ISOTHERM 21 42 -40 C ISOTHERM 14 35

PERC-22

Diameter 2.4mm Shaft Length 13cm

ICEBALL

-20 C ISOTHERM

-40 C ISOTHERM

DIAMETER LENGTH

20 13

23 14

*Data collected using gelatin formula which approximates performance (+5mm) In soft tissue at 10 minutes

FIGURE 3 Illustration of the predicted ice formation achieved with several cryoprobes with the expected temperatures at various depths. Source: Photo courtesy of Endocare, Inc. of Irvine, California, U.S.A.

FIGURE 4 Axial image of the proximal tibia with the patient in the prone position. Note the low attenuation ice ball within the posterolaterally located tumor. The white arrow indicates adjacent neurovascular structures. A small cuff of untreated tumor has been left between the edge of the ice ball (white line) and the posterior margin of the mass (black line) in order to avoid neurologic complications. The structure lying along the skin surface is a sterile glove filled with warm water to prevent skin necrosis.

FIGURE 4 Axial image of the proximal tibia with the patient in the prone position. Note the low attenuation ice ball within the posterolaterally located tumor. The white arrow indicates adjacent neurovascular structures. A small cuff of untreated tumor has been left between the edge of the ice ball (white line) and the posterior margin of the mass (black line) in order to avoid neurologic complications. The structure lying along the skin surface is a sterile glove filled with warm water to prevent skin necrosis.

in treating large, predominantly lytic tumors which have destroyed the bone of origin and extended into the soft tissues. These lesions often have an intimate relationship with surrounding neurovascular structures, damage to which can have serious neurological sequelae for the patient. Preprocedure planning is very important for these lesions in order to avoid these complications, and a small cuff of untreated tumor may have to be left behind to spare these structures (Fig. 4). In addition, many of the patients with such lesions already have widespread metastatic disease and high tumor burden with the goal being palliation and debulking as opposed to cure.

Smaller tumor ablations can be carried out with good conscious sedation and the patient can be discharged the same day. The larger lesions may necessitate general anesthesia and overnight admission for control of postprocedural pain and monitoring for complications.

Certain points of technique should be noted here. The probes are fairly large and have very sharp tips, which may make penetration through pathologic bone possible. As of the writing of this article, there are no introducer sheaths made specifically for use with these probes. The possibility of skin freezing and necrosis should be taken into account when treating superficial lesions, where part of the active probe may traverse or approximate the skin surface. In these cases, it is important to warm the skin (we use warm sterile saline in a sterile glove) to prevent this complication (Fig. 4). It is important to test the probe before inserting it into the patient to ensure that it is functioning properly. This can be achieved by placing the probe in a small container of sterile saline and performing a test freeze. A small amount of ice at the tip of the probe is sufficient for this purpose. A good preprocedure MRI or CT is important to make planning possible. In this way, it is possible to estimate both the number of probes and tanks of gas which will be necessary for the procedure. If pain palliation is the goal, it is important to target any tumor-bone interface as this is felt to be the greatest source of pain.

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