Cryotyerapy

Gatot Purwoto, MD

Gyne-Onocologist
Univ of Indonesia
Jakarta
Indonesia

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KRIOTERAPI 2007
Cryotherapy

Crisp 1967
Tissue destruction at temperature 20C
Freezing Intracelular
Thawing crystalization Cellular damage

CO2 (-600C)
N2O (-900C)

Therapy modality for CERVICAL INTRAEPITHELIAL NEOPLASIA

(CIN)

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Comparable Treatment Modalities for Precancer
Lesion (Cervical Intraepithelial Neoplasia)
Procedure Simple Cost Complication Effectifity

Cryotherapy +++ + + 90%

Loop electrosurgical ++ ++ ++ 95%

excision procedure

Laser Ablation ++ +++ ++ 95%

Laser Excision + +++ ++ 95%

Cold-knife Conization ++ +++ ++ 98%

+, Low ++, Middle +++,Good

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 2 mm

cervix 5 mm

- 20 0C Recovery zone
0 0C Lethal zone

- 85 0C

Recovery zone
probe

Ice ball freezing 7 mm at < 20C - lethal

Not effective for
tissue depthness
0 ~ - 20 0C : recovery zone
0C
> 5mm
- 20 ~ - 85 : lethal zone

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Effectivity of Cryotherapy

Temperature of freezing
Duration of freezing
Probe type
Large & grade of the lesion

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 Indication
VIA test +
Low Grade Lesion (CIN 1 - 2 )
High Grade Lesion (CIN 3 )

Low Grade Lesion : avarage crypt depthness : 1,2 mm

High Grade Lesion : glandular involvement

Cryotherapy only effective for depthness <5 mm

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Preparation

Check cryo-probes, cryo gun, stop

watch, speculum, condoms, water
soluble jelly.
Cryogun - Gas Tank Connector
Gas pressure (>40kg/cm2)

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Patient Preparation

Counseling: indication, technique, side

effects and effectivity
Support not to worry for vaginal discharge
(waterish)or slight bleeding/spotting after
cryotherapy
Suggest not sexual intercourse for 2-4
weeks after cryoptherapy

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KRIOTERAPI 2007
 Procedure

Inserting vaginal speculum

Clean up surface of the cervix identify aceto-white lesion
Applicate water soluble jelly at the tip of cryo-probe
Inserting cryo-probe through the speculum into the cervix
Freeze 3 minutes, thaw 3 -5 min, again freeze 3 minutes,
and then defrost formula 3-5-3-5
Take out cryo-probe slowly

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Failure rate of Cryotherapy

One quadrant 6,8%

Two quadrant 14,1%

Hatch (Clin Obstet & Gynecol 1995)

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Equipment of Cryotherapy

Cryo gun Probes

liquid gas : CO2 or NO2
Water suluble jelly
Disinfectant
Speculum
Acetic acid 3 5 %

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 1. Probe
2. Trigger
10 3. Handle grip
(fiberglass)
1 4. Yoke
2
5. Instrument inlet of
gas from cylinder
7 3 6. Tightening knob
7. Pressure gauge
showing cylinder
pressure
8. Silencer (outlet)
5 9
9. Gas-conveying tube
4 8 10. Probe tip
6

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Advantage & disadvantage of Cryotherapy

Advantage Disadvantage

Effective for CIN 1-3

Simple procedure No specimen for

pathology
No need electicity Watery discharge

No need anesthesia

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 Side Effect

Pelvic cramp (like menstruation)

Watery discharge 2-4 weeks

Spotting

Sometime Pelvic Inflamatory Disease (< 1%)

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Efectivity

CIN 1 CIN 2 CIN 3

Berget, 91 90.9 90.9 86.4
Olatunbosun, 92 83.3 96.9 80.8
Tangtrakul, 83 88.9 85.7 78.5

Double Freeze
cytology + histologic + colposcopy confirmation @ 1 year
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TAKE HOME MESSAGES

Effective in precancer lesion

Cheap (Affordable)
Acceptable
Safe

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KRIOTERAPI 2007