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See and Treat 2007 KRIOTERAPI Cryotyerapy Gatot Purwoto, MD Gyne-Onocologist Univ of Indonesia Jakarta Indonesia.

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Presentation on theme: "See and Treat 2007 KRIOTERAPI Cryotyerapy Gatot Purwoto, MD Gyne-Onocologist Univ of Indonesia Jakarta Indonesia."— Presentation transcript:

1 See and Treat 2007 KRIOTERAPI Cryotyerapy Gatot Purwoto, MD Gyne-Onocologist Univ of Indonesia Jakarta Indonesia

2 See and Treat 2007 KRIOTERAPI Cryotherapy  Crisp 1967  Tissue destruction at temperature –20ºC  Freezing Intracelular Thawing crystalization  CO 2 (-60 0 C)  N 2 O (-90 0 C)  Therapy modality for CERVICAL INTRAEPITHELIAL NEOPLASIA (CIN) Cellular damage

3 See and Treat 2007 KRIOTERAPI Comparable Treatment Modalities for Precancer Lesion (Cervical Intraepithelial Neoplasia) ProcedureSimpleCostComplicationEffectifity Cryotherapy % Loop electrosurgical excision procedure ++ 95% Laser Ablation % Laser Excision % Cold-knife Conization % +, Low ++, Middle +++,Good

4 See and Treat 2007 KRIOTERAPI cervix 0 0 C C 2 mm 5 mm probe C Recovery zone Lethal zone Ice ball freezing 7 mm at < 20ºC - lethal 0 ~ C : recovery zone - 20 ~ C : lethal zone Not effective for tissue depthness > 5mm Recovery zone

5 See and Treat 2007 KRIOTERAPI Effectivity of Cryotherapy  Temperature of freezing  Duration of freezing  Probe type  Large & grade of the lesion

6 See and Treat 2007 KRIOTERAPI Indication VIA test + Low Grade Lesion (CIN ) 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

7 See and Treat 2007 KRIOTERAPI Preparation  Check cryo-probes, cryo gun, stop watch, speculum, condoms, water soluble jelly.  Cryogun - Gas Tank Connector  Gas pressure (>40kg/cm2)

8 See and Treat 2007 KRIOTERAPI 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

9 See and Treat 2007 KRIOTERAPI 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  Take out cryo-probe slowly

10 See and Treat 2007 KRIOTERAPI Failure rate of Cryotherapy  One quadrant 6,8%  Two quadrant14,1% Hatch (Clin Obstet & Gynecol 1995)

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12 See and Treat 2007 KRIOTERAPI Equipment of Cryotherapy Cryo gunProbes liquid gas : CO 2 or NO 2 Water suluble jelly Disinfectant Speculum Acetic acid 3 – 5 %

13 See and Treat 2007 KRIOTERAPI 1.Probe 2.Trigger 3.Handle grip (fiberglass) 4.Yoke 5.Instrument inlet of gas from cylinder 6.Tightening knob 7.Pressure gauge showing cylinder pressure 8.Silencer (outlet) 9.Gas-conveying tube 10.Probe tip

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17 See and Treat 2007 KRIOTERAPI Advantage & disadvantage of Cryotherapy AdvantageDisadvantage Effective for CIN 1-3 Simple procedure No specimen for pathology No need electicityWatery discharge No need anesthesia

18 See and Treat 2007 KRIOTERAPI Side Effect Pelvic cramp (like menstruation) Watery discharge 2-4 weeks Spotting Sometime Pelvic Inflamatory Disease (< 1%)

19 See and Treat 2007 KRIOTERAPI Efectivity CIN 1 CIN 2 CIN 3 Berget, ‘ Olatunbosun, ’ Tangtrakul, ‘ Double Freeze Double Freeze cytology + histologic + colposcopy 1 year

20 See and Treat 2007 KRIOTERAPI TAKE HOME MESSAGES Effective in precancer lesion Cheap (Affordable) Acceptable Safe


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