01. Principles of cryotherapy
How does cellular cryonecrosis work?
Cryosurgery = better immune response
"Post-thawing, mechanically damaged cells die by necrosis and release their contents into the surrounding milieu. Cells that have undergone exosmosis swell and burst due to osmotic shock. Cells in the utmost periphery of the ablation zone exposed to sub-lethal temperatures undergo apoptosis, releasing apoptotic bodies. Antigens released from necrotic cells upon uptake by antigen presenting cells like DCs (Dendritic cells) induce co-stimulatory signals that would result in the generation of anti-tumoral T-cell responses. In contrast, antigen uptake by DCs in the form of apoptotic bodies imprints immune tolerance or anergy on T-cells due to the non-induction of co-stimulatory signals on DCs."Yakkala, C., Chiang, C. L., Kandalaft, L., Denys, A., & Duran, R. (2019) ‘Cryoablation and Immunotherapy: An Enthralling Synergy to Confront the Tumors’, Frontiers in Immunology, 10, 2283. https://doi.org/10.3389/fimmu.2019.02283Speak with an expert
Why is double freezing so important?
• Freezing in two steps results in deeper tissue necrosis. While the first freeze causes tiny spiked chards of extracellular ice, which actually helps preserves cells, the second freeze cause these ice crystals to break through the cell membrane for complete cell destruction.
• A second freeze ensures faster freezing of these cells and their destruction.
Advantages of CryoPen’s controlled cell destruction:
01. No trauma to healthy tissue – low or no pain – no anesthesia needed
02. Less scarring or depigmentation
03. Higher gas-use efficiency – faster treatments
04. Great patient experience – painless and effective
05. The standard treatment for all HPV lesions and keratoses
02. Device preparation
How to load a new cartridge
How to change the applicator
Tips for using your CryoPen
• Always test your CryoPen before performing treatment.
• Always check that your cartridge is empty before replacing it
• If you open your CryoPen when the cartridge still contains N2O, the remaining contents will be expelled, resulting in waste
• Check to be sure the loading cavity is completely clear and empty before loading in a new cartridge
How to clean CryoPen applicators ?
01. Remove the applicator from the CryoPen device
02. Remove the applicator cap
03. Stand the cap and applicator upright in a sterilizing tray/basket
04. Follow the sterilizer manufacturer’s instructions to complete the sterilization process
IMPORTANT: Applicators that touch HPV lesions must be cleaned and sterilized using:PRE-VACUUM AUTOCLAVE 1
34°C/273°F for 4 minutes or 121°C/250°F for 20 minutesGRAVITY DISPLACEMENT STERILIZER
121°C/250°F for 30 minutes
How to treat with CryoPen
• FREEZE – THAW – FREEZE – THAW
• Be guided by your patient’s sensitivity: before starting treatment, pre-freeze and ask the patient to indicate when they feel pain
• Wait 30 seconds between freeze sessions
• Cold penetrates 1mm deep per 3 seconds
• Applicator tip closer to the lesion = higher freezing power to the tissue
What happens during a treatment?
During treatment, patients may feel a sensation similar to a cold ballpoint being pushed onto the skin. During the first few seconds, provided healthy tissue is avoided, they will experience little or no discomfort.
As soon as the ice reaches the caudal extent of the lesion – timing depends on the depth of the lesion – the patient will start to experience discomfort. Stop the treatment at that moment.
There may be residual stinging for a few minutes after treatment. Occasionally, a blister may form and last for a few hours. The area may be itchy, and you should advise the patient to avoid scratching it.Speak with an expert