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Cryosurgery

Last updated March 28, 2019

Approved by: Krish Tangella MD, MBA, FCAP

Warfieldian

Cryosurgery is a procedure that uses freezing cold, compressed liquid nitrogen, to freeze abnormal, infected, or diseased tissue. This image shows a Cryogun that is used to spray liquid nitrogen.


Background Information:

What are the other Names for the Procedure?

  • Cauterization by Cold
  • Cryotherapy

What is Cryosurgery surgical procedure?

Cryosurgery is a procedure that uses freezing cold, compressed liquid nitrogen, to freeze abnormal, infected, or diseased tissue.

What part of the Body does the Procedure involve?

Generally, a Cryosurgery procedure involves the cervix, vagina, skin, or anus.

Why is the Cryosurgery surgical procedure Performed?

Cryosurgery is usually used to treat certain conditions, such as cervicitis (infection of cervix), cervical dysplasia (pre-cancerous condition that may lead to cancer, if left untreated), and prostate cancer in men.

What are some Alternative Choices for the Procedure?

Some alternative choices include:

  • Cauterization: It is a procedure used to destroy abnormal (noncancerous or precancerous) cells on the affected area
  • It can also be carried out through the use of heat, electricity, corrosive chemicals, laser, or surgical excision

What are the Recent Advances in the Procedure?

Use of alternative surgical techniques instead of Cryosurgery, have been some of the advances in the procedure.

What is the Cost of performing the Cryosurgery surgical procedure?

The cost of Cryosurgery procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused by the information regarding Cryosurgery and on what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
  • They can also choose to approach another physician independently. Besides, if the procedure has many alternatives, the patient may take a second opinion to understand and choose the best one

What are some Helpful Resources?

http://www.nlm.nih.gov/medlineplus/ency/article/002917.htm

http://my.clevelandclinic.org/services/cryosurgery/hic_cryosurgery_of_the_cervix.aspx

http://www.thirdage.com/hc/p/14788/cervical-cryosurgery-what-to-expect

http://www.hopkinsmedicine.org/kimmel_cancer_center/centers/cervical_dysplasia/about_cervical_dysplasia.html

http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-treating-cryosurgery

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006

Prior to Cryosurgery surgical procedure:

How is the Cryosurgery surgical procedure Performed?

  • A Cryosurgery may be performed with or without local anesthesia
  • The affected area is first adequately exposed
  • A Cryosurgery probe (a medical instrument that uses freezing cold, compressed liquid nitrogen) is then placed on the area of concern for few minutes, and the abnormal tissue destroyed
  • The application may be repeated after a few minutes

For prostate cancer:

  • Several needles are placed in the skin between the anus and scrotum
  • Needles are then guided into the prostate, using the help of ultrasound, which is accomplished via the rectum (trans rectal ultrasound)
  • Freezing cold gases are then passed through the needles, to destroy the cancer cells
  • This procedure is performed under spinal or epidural anesthesia, where the lower half of the body is anesthetized. Else, it is performed under general anesthesia

Where is the Procedure Performed?

A Cryosurgery is usually performed in an out-patient surgery center facility, a hospital, a physician’s clinic/office, or the emergency room. Normally, the person can go home once the procedure is completed.

Who Performs the Procedure?

A Cryosurgery is performed by a dermatologist, an obstetrician, a gynecologist, a family physician, or a trained general surgeon.

How long will the Procedure take?

A Cryosurgery procedure may take about 10-20 minutes.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

  • Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
  • If you are allergic to any specific medication or food items
  • If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
  • If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
  • If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
  • If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
  • If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
  • A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
  • Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
  • Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
  • Normally, local anesthesia is not used; however do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
  • Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
  • It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
  • Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
  • For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
  • A physician will request your consent for the Cryosurgery procedure using an Informed Consent Form.

What is the Consent Process before the Procedure?

A physician will request your consent for the Cryosurgery procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Cryosurgery surgical procedure?

Before a Cryosurgery procedure, the patient has to undergo certain tests such as:

  • Routine blood and urine analysis
  • Vaginal examination
  • Pap smear

The physician may suggest further tests depending on the health of the patient and their medical history.

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

  • What is a Cryosurgery?
  • Why is this procedure necessary? How will it help?
  • How soon should I get it done? Is it an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed? 
  • What are the risks while performing the procedure?
  • What are the complications that might take place, during recovery?
  • How long will it take to recover? When can I resume normal work?
  • What are the alternatives to the procedure?
  • How many such procedures have you (the physician) performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
  • What are the costs involved?

During the Cryosurgery surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Generally, no anesthesia is administered for this procedure. Sometimes, the physician may administer local anesthesia to the affected area. However, in case of prostate cancer, the procedure is performed under spinal, epidural, or general anesthesia.

How much Blood will you lose, during the Procedure?

Since Cryosurgery is a less invasive procedure, there is little or no blood loss involved.

What are the possible Risks and Complications during the Cryosurgery surgical procedure?

There are usually no surgical risks or complications associated with Cryosurgery. However, there are general factors that increase the risk of getting complications during the procedure, which include:

  • Obesity: Generally greater the degree of obesity, greater is the surgical risk
  • Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
  • Advancing age
  • Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
  • Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
  • Poorly functioning liver, as evidenced by increased blood liver function tests
  • Hypertension (increased blood pressure), especially if it is poorly controlled
  • Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
  • Poor lung function, as evidenced by abnormal lung function tests
  • History of bleeding disorders
  • Longstanding illness, such as autoimmune disorders, chronic infections
  • Poor immune system due to a variety of causes

What Post-Operative Care is needed at the Healthcare Facility after the Cryosurgery surgical procedure?

At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise. 

After the Cryosurgery surgical procedure:

What are the possible Risks and Complications after the Cryosurgery surgical procedure?

Post Cryosurgery, the following complications may arise:

  • In rare cases, infection of the surgical wound may occur
  • Sometimes, using the procedure, it is not possible to completely remove all abnormal tissue
  • Narrowing of the spinal canal (cervical stenosis), if Cryosurgery is performed on the cervix

What is the Prognosis after the Surgery?

  • Individuals who have Cryosurgery performed on skin lesions should expect some swelling and redness, which may develop into a blister within 2-3 days
  • If Cryosurgery is performed on the cervix, a complete recovery is usually expected. However, a foul odor associated with vaginal discharge may occur and last for a period of 7-10 days. A complete recovery from Cryosurgery procedure on the cervix, takes about 3 weeks
  • Some discharge (which is normal) lasting 2-3 weeks, may occur in individuals who undergo anorectal surgery

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

  • Worsening pain surrounding the surgical wound
  • Increase in swelling and redness
  • Bleeding or fluid drainage
  • Fever
  • Dizziness
  • Signs of infection
  • Feeling sick
  • Muscle aches
  • Headache
  • Foul odor of vaginal discharge

What Post-Operative Care is needed at Home after the Cryosurgery surgical procedure?

At home, the following post-operative care is recommended, after a Cryosurgery procedure:

  • Individuals who have undergone anorectal surgery should take warm sitz bath, about twice a day. This can aid in a faster recovery and reduce pain
  • Keep surgical wound dry
  • Wash the incision site with soap
  • Resume showering
  • With cervical therapy, a physician advices follow-up examinations, in order to ensure that treatment is successful and healing complete

How long does it normally take to fully recover, from the Procedure?

After a Cryosurgery, It typically takes less than 3 weeks for a full recovery.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The procedure does not involve the surgical removal of any tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Cryosurgery surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The outpatient facility or a physician’s office
  • A pathologist (if the tissue was sent for analysis)
  • An obstetrician, a gynecologist, a family physician or a general surgeon

The patient is advised to inquire and confirm the type of billing, before the Cryosurgery procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: July 5, 2013
Last updated: March 28, 2019