Editing Cryosurgery

{{Short description|Cauterization by freezing tissue}}
{{More citations needed|date=March 2014}}
{{Infobox medical intervention
| name         = Cryosurgery
| synonym      ='''cryotherapy'''
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| caption      = Cryotherapy to a [[plantar wart]] using cotton bud application
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'''Cryosurgery''' (with ''cryo'' from the [[Ancient Greek]] {{lang|grc|κρύο}} {{gloss|icy cold}}) is the use of extreme cold in [[surgery]] to destroy abnormal or diseased tissue;<ref>{{cite web|url=http://dermnetnz.org/procedures/cryotherapy.html|title=Cryotherapy - DermNet New Zealand|website=dermnetnz.org|date=26 October 2023 }}</ref> thus, it is the surgical application of [[cryoablation]].
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Cryosurgery has been historically used to treat a number of diseases and disorders, especially [[List of skin diseases|a variety of benign and malignant skin conditions]].<ref>{{cite web|url=http://emedicine.medscape.com/article/1125851-overview|title=Cryotherapy: Overview, Mechanism of Action, Treatment Modalities Using Cryotherapy|date=1 June 2016|via=eMedicine}}</ref><ref name="Clebak et al.">{{cite journal |last1=Clebak |first1=KT |last2=Mendez-Miller |first2=M |last3=Croad |first3=J |title=Cutaneous Cryosurgery for Common Skin Conditions. |journal=American Family Physician |date=1 April 2020 |volume=101 |issue=7 |pages=399–406 |pmid=32227823}}</ref>

== History ==
In 1841, English physician James Arnott described therapeutic applications of extremely cold temperatures, namely a mixture of crushed ice and salt applied locally (to skin or [[mucous membrane]]). He theorized his technique was capable of "arresting the accompanying inflammation, and perhaps destroying the vitality of the cancer cell."<ref>{{Cite journal |last=Arnott |first=James |date=7 Feb 1851 |title=Practical Illustrations of the Remedial Efficacy of a Very Low or Anæsthetic Temperature in Cancer |journal=West J Med Surg |volume=7 |issue=2 |pages=154–160 |pmid=38209825}}</ref> His works were the first to hypothesize that extreme cold could be used to selectively damage or destroy harmful tissue.<ref>{{Cite journal |last=Bird |first=H. Marcus |date=1949 |title=James Arnott, M.D. (Aberdeen) 1797-1883: A Pioneer in Refrigeration Analgesia |url=https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2044.1949.tb05803.x |journal=Anaesthesia |volume=4 |pages=10-17}}</ref>

== Uses ==

[[Wart]]s, [[mole (skin marking)|moles]], [[skin tag]]s, [[solar keratosis|solar keratoses]],  [[molluscum contagiosum|molluscum]],<ref name="pmid31239742">{{cite journal| author=Meza-Romero R, Navarrete-Dechent C, Downey C| title=Molluscum contagiosum: an update and review of new perspectives in etiology, diagnosis, and treatment. | journal=Clin Cosmet Investig Dermatol | year= 2019 | volume= 12 | pages= 373–381 | pmid=31239742 | doi=10.2147/CCID.S187224 | pmc=6553952 | doi-access=free }}</ref> [[Morton's neuroma]]<ref>{{cite web|url=http://www.podiatrytoday.com/closer-look-cryosurgery-neuromas|title=A Closer Look At Cryosurgery For Neuromas |website=Podiatry Today |first=Marc |last=Katz |date=May 2013}}</ref> and small [[skin cancer]]s are candidates for cryosurgical treatment. Several [[internal medicine|internal disorders]] are also treated with cryosurgery, including [[Hepatocellular carcinoma|liver cancer]], [[prostate cancer]], lung cancer, oral cancers, [[Cervix|cervical]] disorders and, more commonly in the past, [[hemorrhoids]]. Soft tissue conditions such as [[plantar fasciitis]]<ref>{{Cite web |url=http://www.podiatrytoday.com/article/7883 |title=Case Studies in Cryosurgery for Heel Pain |date=November 2007 |website=Podiatry Today |first=Marc |last=Katz}}</ref> (jogger's heel) and [[fibroma]] (benign excrescence of connective tissue) can be treated with cryosurgery.

Cryosurgery works by taking advantage of the destructive force of freezing temperatures on [[Cell (biology)|cells]]. When their [[temperature]] sinks beyond a certain level [[ice crystal]]s begin forming inside the cells and, because of their lower [[density]], eventually tear apart those cells. Further harm to malignant growth will result once the [[blood vessel]]s supplying the affected tissue begin to freeze.

Cryosurgery is used to treat a variety of benign skin [[lesion]]s including:<ref name="Clebak et al." />
* [[Acne]]
* [[Dermatofibroma]]
* [[Hemangioma]]
* [[Keloid]] (hypertrophic scar)
* [[Molluscum contagiosum]]
* [[Myxoid cyst]]
* [[Pyogenic granuloma]]
* [[Seborrheic keratoses]]
* [[Skin tags]]
* [[Warts]] (including anogenital warts)

Cryosurgery may also be used to treat low risk skin cancers such as [[basal cell carcinoma]] and [[squamous cell carcinoma]] but a biopsy should be obtained first to confirm the diagnosis, determine the depth of invasion and characterize other high risk histologic features.<ref name="Clebak et al." />

== Method ==

===Liquid nitrogen===
[[Image:Cryogun.jpg|right|thumb|Cryogun used to spray liquid nitrogen]]
A common method of freezing lesions is by using [[liquid nitrogen]] as the cryogen. The liquid nitrogen may be applied to lesions using a variety of methods, such as dipping a cotton or synthetic material tipped applicator in liquid nitrogen and then directly applying the cryogen onto the lesion.<ref name="Clebak et al." /> The liquid nitrogen can also be sprayed onto the lesion using a spray canister. The spray canister may utilize a variety of nozzles for different spray patterns.<ref name="Clebak et al." /> A cryoprobe, which is a metal applicator that has been cooled using liquid nitrogen, can also be directly applied onto lesions.<ref name="Clebak et al." />

=== Carbon dioxide ===
Carbon dioxide is also available as a spray and is used to treat a variety of benign spots. Less frequently, doctors use [[carbon dioxide]] "snow" formed into a cylinder or mixed with [[acetone]] to form a slush that is applied directly to the treated tissue.{{Citation needed|date=October 2022}}

===Argon===
Recent advances in technology have allowed for the use of [[argon]] gas to drive ice formation using a principle known as the [[Joule-Thomson effect]]. This gives physicians excellent control of the ice and minimizes complications using ultra-thin 17 [[Stubs Iron Wire Gauge|gauge]] cryoneedles.{{Citation needed|date=October 2022}}

=== Freeze sprays ===
A mixture of [[dimethyl ether]] and [[propane]] is used in some "[[freeze spray]]" preparations such as [[Dr. Scholl's]] Freeze Away. The mixture is stored in an [[aerosol spray]] type container at room temperature and drops to {{convert|-41|C|F}} when dispensed. The mixture is often dispensed into a straw with a cotton-tipped swab. Similar products may use [[tetrafluoroethane]] or other substances.{{Citation needed|date=October 2022}}

== Products ==
{{unreferenced section|date=November 2017}}
;Cryosurgical systems
A number of medical supply companies have developed [[cryogen]] delivery systems for cryosurgery. Most are based on the use of liquid nitrogen, although some employ the use of proprietary mixtures of gases that combine to form the cryogen.

==In cancer treatment==
Cryosurgery is also used to treat internal and external tumors as well as tumors in the bone. To cure internal tumors, a hollow instrument called a cryoprobe is used, which is placed in contact with the tumor. Liquid [[nitrogen]] or [[argon]] gas is passed through the cryoprobe. [[Ultrasound]] or [[MRI]] is used to guide the cryoprobe and monitor the freezing of the cells. This helps in limiting damage to adjacent healthy tissues. A ball of ice crystals forms around the probe which results in freezing of nearby cells. When it is required to deliver gas to various parts of the tumor, more than one probe is used. After cryosurgery, the frozen tissue is either naturally absorbed by the body in the case of internal tumors, or it dissolves and forms a scab for external tumors.<ref>{{cite web|url=http://www.cancer.gov/about-cancer/treatment/types/surgery/cryosurgery-fact-sheet|title=Cryosurgery in Cancer Treatment|website=National Cancer Institute|date=2005-09-09}}</ref>

== Results ==
Cryosurgery is a [[minimally invasive]] procedure, and is often preferred to other types of surgery because of its safety, ease of use, minimal pain and scarring as well as low cost;<ref name="Clebak et al." /> however, as with any medical treatment, there are risks involved, primarily that of damage to nearby healthy tissue. Damage to [[Nerve|nerve tissue]] is of particular concern but is rare.<ref name="Clebak et al." />

Cryosurgery cannot be used on lesions that would subsequently require biopsy as the technique destroys tissue and precludes the use of [[histopathology]].<ref name="Clebak et al." />

More common complications of cryosurgery include blistering and edema which are transient.<ref name="Clebak et al." /> Cryosurgery may cause complications due to damage of underlying structures. Destruction of the [[basement membrane]] may cause scarring and destruction of hair follicles can cause [[alopecia]] or hair loss.<ref name="Clebak et al." /> Occasionally, [[hypopigmentation]] may occur in the area of skin treated with cryosurgery, however, this complication is usually transient and often resolves as [[melanocytes]] migrate and repigment the area over several months.<ref name="pmid15168956">{{cite journal| author=Andrews, MD| title=Cryosurgery for common skin conditions. | journal=American Family Physician | year= 2004 | volume= 69 | issue= 10 | pages= 2365–72 | pmid=15168956 | url=https://www.aafp.org/afp/2004/0515/p2365.html#afp20040515p2365-b4  }}</ref> Bleeding can also occur, which can be delayed or immediate, due to damage of underlying arteries and arterioles.<ref name="Clebak et al." /> Tendon rupture and cartillage necrosis can occur, particularly if cryosurgery is done over bony prominences.<ref name="Clebak et al." /> These complications can be avoided or minimized if freeze times of less than 30 seconds are used during cryosurgery.<ref name="Clebak et al." />

Patients undergoing cryosurgery usually experience redness and minor-to-moderate localized pain, which most of the time can be alleviated sufficiently by oral administration of mild [[analgesics]] such as [[ibuprofen]], [[codeine]] or [[acetaminophen]] (paracetamol). [[Blister]]s may form as a result of cryosurgery, but these usually scab over and peel away within a few days.

== See also ==
* [[Cauterization#Chemical cautery|Chemical cautery]]
* [[Cryoneurolysis]]
* [[Cryotherapy]]
* [[Electrosurgery]]

==References==
{{reflist}}

{{Authority control}}

[[Category:Dermatologic surgery]]
[[Category:Cryobiology]]
[[Category:Surgical procedures and techniques]]

[[de:Kryotherapie#Kryochirurgie]]