Are Multiple Cryoprobes Additive or Synergistic in Renal Cryotherapy?

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

doi:10.1016/j.urology.2011.10.042

Cited by 16 publications

(10 citation statements)

References 25 publications

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“…21 Young et al confirmed this finding, concluding that the ice ball volumes increased in size more than expected when pulses were used in tandem, demonstrating that cryolesions that are created by multiple simultaneous 1.47-mm probes have a synergistic effect. 22…”

Section: Literature Reviewmentioning

confidence: 99%

Laparoscopic Renal Cryoablation

Schiffman

Moshfegh

Talenfeld

et al. 2014

Semin intervent Radiol

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In light of evidence linking radical nephrectomy and consequent suboptimal renal function to adverse cardiovascular events and increased mortality, research into nephron-sparing techniques for renal masses widely expanded in the past two decades. The American Urological Association (AUA) guidelines now explicitly list partial nephrectomy as the standard of care for the management of T1a renal tumors. Because of the increasing utilization of cross-sectional imaging, up to 70% of newly detected renal masses are stage T1a, making them more amenable to minimally invasive nephron-sparing therapies including laparoscopic and robotic partial nephrectomy and ablative therapies. Cryosurgery has emerged as a leading option for renal ablation, and compared with surgical techniques it offers benefits in preserving renal function with fewer complications, shorter hospitalization times, and allows for quicker convalescence. A mature dataset exists at this time, with intermediate and long-term follow-up data available. Cryosurgical recommendations as a first-line therapy are made at this time in limited populations, including elderly patients, patients with multiple comorbidities, and those with a solitary kidney. As more data emerge on oncologic efficacy, and technical experience and the technology continue to improve, the application of this modality will likely be extended in future treatment guidelines.

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Section: Literature Reviewmentioning

confidence: 99%

Laparoscopic Renal Cryoablation

Schiffman

Moshfegh

Talenfeld

et al. 2014

Semin intervent Radiol

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“…Unfortunately, limited information is available on the expected ice ball size for multiple probes, and for nonstandard ablation times. In multiple-probe ablation, there is a variable amount of synergy between the probes, which can result in a larger ablation zone than expected [12; 13]. …”

Section: Introductionmentioning

confidence: 99%

“…However, accurate simulations are too slow for routine clinical use, and simple ice ball models are inaccurate due to synergy between probes [12]. …”

Section: Introductionmentioning

confidence: 99%

Development of a Searchable Database of Cryoablation Simulations for Use in Treatment Planning

Boas

Srimathveeravalli

Durack

et al. 2017

Cardiovasc Intervent Radiol

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Purpose To create and validate a planning tool for multiple-probe cryoablation, using simulations of ice ball size and shape for various ablation probe configurations, ablation times, and types of tissue ablated. Materials and methods Ice ball size and shape was simulated using the Pennes bioheat equation. 5670 different cryoablation procedures were simulated, using 1-6 cryoablation probes and 1-2 cm spacing between probes. The resulting ice ball was measured along three perpendicular axes and recorded in a database. Simulated ice ball sizes were compared to gel experiments (26 measurements) and clinical cryoablation cases (42 measurements). The clinical cryoablation measurements were obtained from a HIPAA-compliant retrospective review of kidney and liver cryoablation procedures between January 2015 and February 2016. Finally, we created a web-based cryoablation planning tool, which uses the cryoablation simulation database to look up the probe spacing and ablation time that produces the desired ice ball shape and dimensions. Results Average absolute error between the simulated and experimentally measured ice balls was 1 mm in gel experiments, and 4 mm in clinical cryoablation cases. The simulations accurately predicted the degree of synergy in multiple-probe ablations. The cryoablation simulation database covers a wide range of ice ball sizes and shapes up to 9.8 cm. Conclusion Cryoablation simulations accurately predict the ice ball size in multiple-probe ablations. The cryoablation database can be used to plan ablation procedures: given the desired ice ball size and shape, it will find the number and type of probes, probe configuration and spacing, and ablation time required.

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“…Currently, commercial systems are nearly non existent, and emerging tools are limited to a visualization of the isotherms obtained for each needle in ideal conditions (usually in a gel). They do not account for any influence of the soft tissue properties, the presence of blood vessels, or the combined effect of multiple needles highlighted in [Young et al 2012]. As a consequence, large safety margins over 5 mm are defined, as detailed in [Georgiades et al 2012].…”

Section: Introductionmentioning

confidence: 99%