Basic and Translational ScienceAre Multiple Cryoprobes Additive or Synergistic in Renal Cryotherapy?
Section snippets
Material and Methods
Three female Yorkshire farm pigs weighing 39-42 kg were used in the present study, which was approved by the institutional animal care and use committee. After premedication with intramuscular 0.05 mg/kg atropine, anesthesia was induced with intramuscular 6 mg/kg telazol and 2 mg/kg xylazine. An ear vein cannula was placed and the pig intubated. Anesthesia was induced with 4%-5% isoflurane and maintained at 1%-2%. The pigs were placed in the left lateral decubitus position and insufflated with
Results
Cryolesions were created in the upper and lower pole of both kidneys in all 3 pigs. No intraoperative complications or deaths occurred. The mean operating time was 3.6 hours for the single probe group and 3.3 hours for the multiple probe group. Each single probe trial was multiplied by 3 to compare the results of a single probe multiplied by 3 (additive arm) with the results for the 3 probes activated simultaneously (synergistic arm). In the single probe group multiplied by 3, the average
Comment
Three-dimensional numeric simulations of multiple 1.47 mm (17-gauge) cryoprobes were matched with experimental data in a phase-changing gel by Magalov et al.13 They found additional cryoprobes resulted in an increased expansion of the isotherm in all 3 directions and cited this as clear evidence of the synergistic effect of multiple cryoprobes. They found the effect of different placement decreased as the density of the probes increased. They cautioned against placing the probes too close
Conclusions
The cryolesion created by 3 simultaneously activated 1.47-mm probes appears to be synergistic rather than additive. The lesions created by 3 simultaneously activated cryoprobes 1-cm apart were significantly larger as measured by ultrasonography. Moreover, the gross cryolesion volume showed a trend for being larger (P = .06).
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Financial Disclosure: BK Medical provided the use of an ultrasound machine and laparoscopic ultrasound probe for the study. Department of Urology, University of California, Irvine, provided the use of the Atellas Education Center as a study site, including laparoscopic surgical equipment, preoperative animal housing, and animal disposal.
Funding Support: Galil Medical, Inc. provided financial support and the use of a PresIce cryotherapy machine and IceRods for the study.