1. Cryotyerapy Gatot Purwoto, MD Gyne-Onocologist Univ of Indonesia Jakarta Indonesia

2. Cryotherapy Cellular damage Crisp 1967
Tissue destruction at temperature –20ºC
Freezing Intracelular
Thawing crystalization
CO2 (-600C)
N2O (-900C)
Therapy modality for CERVICAL INTRAEPITHELIAL NEOPLASIA (CIN)
Cellular damage

3. Comparable Treatment Modalities for Precancer Lesion (Cervical Intraepithelial Neoplasia)
Procedure
Simple
Cost
Complication
Effectifity
Cryotherapy
+++ +
90%
Loop electrosurgical
excision procedure ++
95%
Laser Ablation
Laser Excision
Cold-knife Conization
98%
+, Low ++, Middle ,Good

4. Not effective for tissue depthness > 5mm
cervix
Recovery zone
- 20 0C
0 0C
Lethal zone
- 85 0C
Recovery zone
probe
Ice ball freezing 7 mm at < 20ºC - lethal
0 ~ C : recovery zone
- 20 ~ C : lethal zone
Not effective for tissue depthness
> 5mm

5. Effectivity of Cryotherapy
Temperature of freezing
Duration of freezing
Probe type
Large & grade of the lesion

6. 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

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

8. 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. 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. Failure rate of Cryotherapy
One quadrant 6,8%
Two quadrant 14,1%
Hatch (Clin Obstet & Gynecol 1995)

12. Equipment of Cryotherapy
Cryo gun
Probes
liquid gas : CO2 or NO2
Water suluble jelly
Disinfectant
Speculum
Acetic acid 3 – 5 %

13. 3. Handle grip (fiberglass) 4. Yoke
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 1 7 3 2 6 4 5 8 9 10

17. Advantage & disadvantage of Cryotherapy
Effective for CIN 1-3
Simple procedure
No specimen for pathology
No need electicity
Watery discharge
No need anesthesia

18. Side Effect Pelvic cramp (like menstruation)
Watery discharge 2-4 weeks
Spotting
Sometime Pelvic Inflamatory Disease (< 1%)

19. cytology + histologic + colposcopy confirmation @ 1 year
Efectivity
CIN CIN CIN 3
Berget, ‘
Olatunbosun, ’
Tangtrakul, ‘
Double Freeze
cytology + histologic + colposcopy 1 year

20. TAKE HOME MESSAGES Effective in precancer lesion Cheap (Affordable)
Acceptable
Safe