Modern surgery is impossible to be imagined without low-invasive interventions minimizing trauma of patients. Today, using, particularly, cryogenic temperatures, relative simplicity of manipulations succeeded to be reached almost painless performance, no bleedings, high accuracy and efficiency of treatment in different branches of medicine, especially when traditional methods of therapy appear to be helpless.
Though cryosurgery cannot be considered as panacea in all possible operative measures, nowadays this set of cryosurgical technologies which experts usually use in complex therapy of patients is a perspective method of treatment. Today Ukraine is of interest for foreigners because of active introduction of cryosurgical method in different branches of medicine, as the newest cryosurgical device “Cryo-Pulse” was invented exactly in our country, and the method itself is not worthy without it.
Some days ago, delegation of Indian specialists visited Kyiv and had conversation with leading experts used cryosurgery in practical medicine.
Practice is the measure of knowledge and method assessment
First of all the Indian experts, practitioner Chandagal Madhu, doctor Ball Baskaran and businessman Hemant Kumar, have become interested in the most widespread diseases which are common for all mankind irrespective of residing area: tumours of skin, head and neck, breast cancer, tumours of liver and pancreas, as well as using of cryosurgery in gynecology and proctology where the newest technologies not only facilitate reaching of desired effect but also prolong life of patients and keep quality of their life.
Visitors were convinced that it all became possible thanks to unique domestic device “Cryo-Pulse” which allows to reach optimum temperature in the focus of lesion, acting precisely on targeted pathological area, and not damaging healthy tissues. Earlier nobody can achieve it.
The result of using of cryogenic temperatures (to 190 degrees subzero centigrade) depends on technical parameters of cooling process: slow freezing and slow thawing is favourable for tissues conservation (cryotherapy), and the snap-freezing and slow thawing resulted in its destructions (cryodestruction).
Visitors from India were interested exactly in destruction of pathological cells and tissues. Therefore itinerary of their visit to capital considered their wishes first of all. Ukrainian specialists who use method of cryodestruction over 7-10 years were selected. They were Igor Palazyuk, highest category cancer surgeon from the Department of tumours of skin, head and neck at the Regional hospital No. 1; Professor Oleksandr Lytvynenko, Doctor of medical sciences, Head of the Department of general oncology and reconstructive surgery of breast at the Institute of oncology АМSU; Professor Volodymyr Chernev, Chief of the Department of abdominal and low-invasive surgery, Colonel of medical service of the Main military clinical hospital of the Ministry of Defense of Ukraine; Professor Oleksiy Dronov, Doctor of medical sciences, Head of the Chair of general surgery No. 1 at the Bogomolets NMU, Scientific supervisor of the Kyiv centre of liver, gall ducts and pancreas; Professor Anatoly Senchuk, Doctor of medical sciences, Head of the Chair of obstetrics and gynecology of the Medical institute of the Ukrainian association of folk medicine; Vladyslav Korolenko, candidate of medical sciences, Assistant of the Chair of faculty surgery at the Bogomolets NMU, Chief coloproctologist of the Southwest railway of the Road hospital No. 1, Kyiv.
Death of pathological cells during cryodestruction
Process of cryodestruction includes number of responses, where the following mechanisms involved:
* — thermal shock which is evident when protoplasm became immobile;
* — appreciable dehydration of cells during formation, first, extracellular, and then intracellular ice;
* — formation of intracellular crystals of ice, mechanical destruction of cellular membrane and compression of cells with crystals;
* — denaturation of cellular proteins and phospholipids in cellular membranes;
* — microvascular trauma or termination of circulation in the refrigerated tissue resulted into necrosis.
Histological evidences show that connective tissue and elastic structure of an organ are preserved after cryodestruction. The positive is that after thawing blood flow is recommenced in great vessels (inferior vena cava, portal vein, aorta and major artery) and damaged endothelium promptly regenerates. This cryotechnological peculiarity allows to perform cryodestruction of nonresectable tumours extended in great vessels. Temperature intervals of cell death are specific for every tissue. In particular, blood vessels and bone tissue are proved to have the greatest resistance to freezing, so cell destruction is reached at the lower temperatures.
Therefore Indian experts were interested almost in everything: temperature regimens and time for freezing tumours of different localization, areas for tissues freezing and thawing, cryoinstrumentation and cryoapplicators, long-term results of cryodestructiones etc.
Application of cryogenic temperatures, in particular, during the surgery of breast cancer which visitors observed in Oleksandr Lytvynenko’s masterly performance at the Institute of Oncology AMS of Ukraine, and they were impressed with both effect of operation and skill of surgeon. Professor often has to deal with nonresectable tumours which, by means of chemiotherapy, he firstly “transforms” into resectable form and then, after tumour cryodestruction, performs mastectomy. During freezing tumour not only perishes, but it also lost ability to dissemination. Long-term results shows that rate of recurrence-free survival of patients who undergone tumour cryodestruction before mastectomy is 27 %.
Cryodestruction allows to minimize surgical traumatism, in particular, in metastatic neoplasms of liver. For the first time in world surgical practice, manufacturers of cryosurgical equipment together with medical practitioners have developed method of laparoscopic cryodestruction of hepatic and pancreatic tumours. For this purpose special cryolaparoscopic instrument was designed, and one of inventors and at the same time doctor-practitioner Volodymyr Chernev shows it to guests.
- The idea of creating this unique instrument appeared when optimum accesses to different departments of liver and for different levels of tumours localization had emerged, - Colonel of medical service tells. - This search became more urgent with a rush of patients which have already undergone some operative measures and more than one course of chemiotherapy. They were physically and morally emaciated people whom traditional methods were contraindicated because of high trauma and non-optimistic consequences. At the same time laparoscopic cryodestruction allows not only to minimize trauma, but also promote prompt patients rehabilitation. Survival rate for such patients increased on the average from several months to several years. In respect of survival we were helped by specialists from metropolitan Kavetsky Institute of Observational pathology, oncology and clinical radiobiology NAS of Ukraine who made from excised tumour autovaccine for patients able to raise immune status of the body. Experts from India were interested in diameter of tumour exposed to freezing because it can be larger than cryoapplicator used for cryodestruction. Volodymyr Chernev’s practice shows that diameter covered the following field of freezing must partly overlap the previous one even so that full coverage of tumour provides for 1 cm increasing of diameter covering of healthy tissue. To eliminate tumour extended into the great vessel is impossible without cryomethod. Indian guests were convinced in it when observed three parallel operations (two on pancreas of different localization and on liver) performed by Professor Oleksiy Dronov.
- Now I wonder how we can did without cryosurgery earlier, - professor tells. - Cryosurgical method gives an opportunity not only to eliminate tumours almost inaccessible to traditional procedures, but also influence the further effective treatment of patients, in particular, chemotherapy. Certainly, it became possible only thanks to application of the present rector of the Medical University, Professor Vitaly Moskalenko, Doctor of medical sciences, when four cryosurgical devices “Cryo-Pulse” were purchased for leading chairs of Bogomolets NMU some years ago. Now young generation studies on them according to the rector’s order.
Also, good effects of cryomethod guests saw in maternal clinic KMCH No.1 where Professor Anatoly Senchuk works. Efficacy rate of the newest method used in treatment of patients with precancer diseases of uterine cervix is 98,5 %. Cryosurgery in gynecology is highly effective, low-invasive and performed in out-patient facilities, and is applied in treatment of other diseases which earlier caused women disability (adenomiosis, endometrial cancer, etc.). Now, thanks to the newest technologies, we can help great number of women whom surgical treatment and hormonal therapy are contraindicated because of number of concomitant pathologies, such as diabetes mellitus, obesity, varicose disease, etc.
Advantages and potential of cryosurgical method
* — Allows to destroy completely the given volume of pathological tissue both on surface and in the deep of a body.
* — Low trauma.
* — Painless.
* — Practically bloodless.
* — Ablastic, dissemination of malignant cells is excluded.
* — Good in complex treatment.
* — Multiple cycles of exposure are possible.
* — Expands potential of radical treatment.
* — Does not cause coarse cicatrices.
* — Possible immune responses of a body against preserved recurrent malignant cells.