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Subject: Cervical Cryotherapy
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The device consists of a gas tank containing nonexplosive, nontoxic gases (usually nitrous oxide but sometimes carbon dioxide).
A 20-lb gas cylinder is preferable to the 6-lb E-type tank, because the former has a more efficient pressure release curve.
Liquid nitrogen has been used in the past, but it is difficult to control and is not recommended.
Tanks are usually obtained from local suppliers.
Appropriately sized vaginal specula.
Adequate light source.
Cervical probes in a variety of sizes.
Treatment of biopsy-proven cervical intraepithelial neoplasia 2 and 3 lesions
Cervical intraepithelial neoplasia (CIN) 1 lesions persistent for 2 or more years, especially in women who do not wish to have children
An unsatisfactory colposcopic examination.
A lesion that extends more than 3 or 4 mm into the cervical os because the area of destruction may not reliably penetrate beyond this level.
A positive endocervical curettage.
A lesion that covers more than two quadrants of the cervix.
A lesion that cannot be completely covered by the cryoprobe.
CIN 3 lesions (relative contraindication). There may be a higher recurrence rate compared with LEEP for CIN 3 level lesions, possibly because of the greater depth of glandular involvement with CIN 3.
A mismatch of cytologic, histologic, and colposcopic findings greater than two histologic grades.
Some physicians recommend using an excisional therapy (e.g., LEEP) for recurrent dysplasia after ablative therapy.
Adenocarcinoma in situ (should have cold knife conization).
Lesion not fully visible or extending beyond the range of the cryotherapy probe.
Biopsy consistent with or suspicious for invasive carcinoma.
PITFALL: Be careful not to allow the cryoprobe to touch the vaginal side wall, because it may stick to and freeze the vagina. The operator may quickly push the vaginal mucosa off the probe with a tongue blade or with a slight twist of the probe. If this is not done quickly, it will become more difficult as the freeze deepens, and more vaginal mucosa will be destroyed. The operator should defrost the probe just enough to release the sidewall and then continue the freeze.
PITFALL: Fainting and light-headedness are not uncommon. Have the patient rest supine for at least several minutes and then sit up slowly.
Women will experience a heavy discharge for several weeks after cryotherapy. Amino-Cerv cream (one applicator high in the vagina Qhs for 10 days) may be used after therapy in an attempt to decrease the discharge, although this use is not well studied. Cervical eschar debridement does not shorten the length or amount of discharge.
Bleeding and infection (rare).
Undergoing cryotherapy of the uterine cervix increases the risk that a follow-up colposcopic examination will be inadequate. The squamocolumnar junction has a tendency to migrate deeper into the cervical os, making it difficult to sample the endocervix. This is especially true of older nipple-tipped probes, which are not currently recommended.
Development of carcinoma after cryotherapy (failure of therapy).
Anaphylactoid reaction to the cold exposure.
Theoretical concerns about reduced fertility include the induction of cervical stenosis, a detrimental effect on cervical mucus, cervical incompetence, and tubal dysfunction secondary to ascending infection. No strong clinical evidence supports any of these concerns.
Cooper Surgical, Shelton, CT. Phone: 1-800-645-3760 or 203-929-6321. Web site: http://www.coopersurgical.com.
Ellman International, Inc., Hewlett, NY. Phone: 1-800-835 5355 or 516-569-1482. Web site: http://www.ellman.com.
Olympus America, Inc., Melville, NY. Phone: 1-800-548-555 or 631-844-5000. Web site: http://www.olympusamerica.com.
Utah Medical Products, Inc., Mid-vale, UT. Phone: 1-800-533-4984 or 801-566-1200. Web site: http://www.utahmed.com.
Wallach Surgical Devices, Inc., Orange, CT. Phone: 1-800-243-2463 or 203-799-2000. Web site: http://www.wallachsurgical.com.
Welch Allen, Skaneateles Falls, NY. Phone: 1-800-535-6663 or 315-685-4100. Web site: http://www.welchallyn.com.