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Bronchoscopic cryotechniques in adults

Author
Henri G Colt, MD
Section Editor
Praveen N Mathur, MB, BS
Deputy Editor
Geraldine Finlay, MD

INTRODUCTION

Several bronchoscopic cryosurgical techniques are available that employ extremely low temperatures to freeze tissue for destruction (cryoablation), adhesion (cryoadhesion), or biopsy (cryobiopsy) [1-3]. The most common of these is cryoablation, a procedure that is mostly used to manage inoperable airway obstruction. The equipment, principles, techniques, indications, contraindications, and complications of these modalities are reviewed here. Other bronchoscopic techniques used to manage airway obstruction are described separately. (See "Clinical presentation, diagnostic evaluation, and management of central airway obstruction in adults" and "Endobronchial electrocautery" and "Endobronchial photodynamic therapy in the management of airway disease in adults" and "Bronchoscopic argon plasma coagulation in the management of airway disease in adults" and "Airway stents" and "Flexible bronchoscopy balloon dilation" and "Endobronchial brachytherapy".).

EQUIPMENT

Bronchoscopic cryotechniques require a cryosurgery device (ie, cryoprobe or cryoforceps), bronchoscope, and cooling agent (ie, cryogen). Only experts skilled in the use of this equipment should perform cryosurgery (picture 1).

Cryosurgery device — Cryosurgery devices consist of a cryoprobe (ablative or adhesive procedures) or a cryoforceps (biopsy procedures), a transfer line, and a console. The cryoprobe/forceps is used to freeze the target tissue. The transfer line connects the cryoprobe/forceps to both the cooling agent storage container (eg, gas cylinder) and the console. The console controls the flow of cooling agent through the transfer line. (See 'Cryoablation' below and 'Cryoadhesion' below and 'Cryobiopsy' below.)

Cryoprobes may be rigid, semirigid, or flexible. Rigid cryoprobes have a system of reheating that induces a nearly immediate thaw phase, whereas thawing is a passive process with flexible cryoprobes, such that the freeze-thaw cycle is longer with the latter. Cryoforceps are typically flexible.

Bronchoscope — Rigid and semirigid cryoprobes can be used through a rigid bronchoscope only, whereas flexible cryoprobes and forceps can be used through either a flexible or a rigid bronchoscope. (See "Flexible bronchoscopy in adults: Overview" and "Rigid bronchoscopy: Instrumentation".)

                       

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Literature review current through: Nov 2016. | This topic last updated: Tue Nov 22 00:00:00 GMT 2016.
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