Prostate Cryoablation Technique

1
Prostate Cryoablation Technique
2
Four Steps

• Ultrasound Capture
• Probe Planning
• Probe Placement
• Freeze / Thaw Cycles

3
Step 1 Ultrasound Capture

• Place Foley Catheter, fill bladder with saline
• Align ultrasound probe, center image, assure that
  plane of urethra and plane of transducer is
  parallel
• Urethra should stay on centerline as you move
  ultrasound cradle from base to apex
• Measure volume (height, width, length)

4
Transverse Mid Gland Ultrasound
5
Sagittal Ultrasound Anatomy
6
Ultrasound Capture
7
Step 2Cryoprobe Temprobe Planning

• Outline the prostate margin (stay outside the
  capsule for high risk disease where capsular
  disease is suspected)
• Outline urethra (allow a large margin for salvage
  cases)
• Outline rectal wall

8
Cryoprobe Temprobe Planning Software

• Outline
• Margin
• Urethra
• Rectal

9
Cryoprobe Temprobe Planning Software

• Cryoguide placement
• logic recommends
• - Cryoprobe
• - Temprobe

Add/Subtract Probes Check measurements
10
CryoProbeTM Placement Logic

• ? 1 cm from the capsule
• ? 2 cm apart
• gt 0.5 cm from rectal wall
• gt 0.5 cm from urethral wall

-40 C D 1.96 cm L 3.85 cm
11
Cryoprobe Temprobe Planning Software
12
Step 3Probe Placement Sequence

• Placement Sequence
• Anterior - CryoProbes 1 2
• Midline - Ant, ES, Apex, DEN TempProbes
• Posterior Medial - CryoProbes 5 6
• Posterior Lateral - CryoProbes 3 4
• Lateral - RNVB, LNVB TempProbes
• Urethra - Urethral Warming Catheter