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Differences in Ablation Size in Porcine Kidney, Liver, and Lung After Cryoablation Using the Same Ablation Protocol

Sompol Permpongkosol1,2, Theresa L. Nicol3, Richard E. Link1,4, Ioannis Varkarakis1, Hema Khurana5, Qihui Jim Zhai5, Louis R. Kavoussi1,6 and Stephen B. Solomon1,7

1 James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, MD.
2 Present address: Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
3 Department of Pathology, Johns Hopkins Bayview Medical Center, Baltimore, MD.
4 Present address: Scott Department of Urology, Baylor College of Medicine, Houston, TX.
5 Department of Pathology, The Methodist Hospital, Houston, TX.
6 Present address: Institute for Urology, North Shore LIJ Health System, Long Island, New York, NY.
7 Present address: Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY.


Figure 1
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  		Fig. 1 —Schematic of study design shows cryoprobe placement during freezing process, with temperature probes placed at 5, 10, 15, 20, and 25 mm from cryoprobe.

 

Figure 2
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  		Fig. 2 —Positioning of temperature probes in kidney is confirmed with sonography. Sonogram shows tips of thermocouples as hyperechoic spots. Acoustic shadowing caused by ice ball is seen.

 

Figure 3
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  		Fig. 3A —Temperatures during cryotherapy. Graphs show mean temperatures at different time points during cryotherapy measured at varying distances from cryoprobe in porcine kidney (A), lung (B), and liver (C) during entire double freezing cycle. Thermometer probes were inserted at 5, 10, 15, 20, and 25 mm from axis of cryoprobes.

 

Figure 4
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  		Fig. 3B —Temperatures during cryotherapy. Graphs show mean temperatures at different time points during cryotherapy measured at varying distances from cryoprobe in porcine kidney (A), lung (B), and liver (C) during entire double freezing cycle. Thermometer probes were inserted at 5, 10, 15, 20, and 25 mm from axis of cryoprobes.

 

Figure 5
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  		Fig. 3C —Temperatures during cryotherapy. Graphs show mean temperatures at different time points during cryotherapy measured at varying distances from cryoprobe in porcine kidney (A), lung (B), and liver (C) during entire double freezing cycle. Thermometer probes were inserted at 5, 10, 15, 20, and 25 mm from axis of cryoprobes.

 

Figure 6
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  		Fig. 4A —Photomicrographs of ablated tissue. In kidney, clear demarcation is seen between viable (R) and infarcted kidney (L). Area indicated by R shows viable tubules and mild intervening interstitial fibrosis. Area indicated by L shows tubules lined by nucleated, hypereosinophilic epithelium and desquamated necrotic cells and debris in lumen.

 

Figure 7
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  		Fig. 4B —Photomicrographs of ablated tissue. In lung, right side of photomicrograph displays normal lung architecture that has clear demarcation in center. Left side shows infracted lung parenchyma, congested alveolar capillaries, and compressed alveoli (focal) filled with amorphous pink material.

 

Figure 8
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  		Fig. 4C —Photomicrographs of ablated tissue. In liver, area of infarction (lower left field) with poorly stained and mummified hepatocytes and occasional lysed nuclei is seen. Scattered congested sinusoids are also noted. Hexagonal liver architecture is retained.

 

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