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Pushkarev AV, Ryabikin SS, Saakyan NY, Tsiganov DI, Burkov IA, Vasilev AO. A study of prostate multiprobe cryoablation near urethra for precision treatment planning. Cryobiology 2022; 109:10-19. [PMID: 36283423 DOI: 10.1016/j.cryobiol.2022.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/14/2022] [Accepted: 10/15/2022] [Indexed: 02/06/2023]
Abstract
The simplified preoperative planning of multiprobe prostate cryoablation limits its efficiency. In order to improve it, the thermal history prediction software is being developed. However, the problem of high risks at the prostate-urethra boundary has not been solved yet. The urethral warming system is used to protect the urethral canal from freezing. On the one hand it is used to reduce the risk of damage to the urethra; on the other hand it increases the risk of insufficient ablation of the tumor. This paper presents a step towards the possibility of carrying out the precision prostate cryoablation in this region. For the experimental part, three cases of arrangement of one and two argon cryoprobes and a heating catheter have been considered. Freezing zone shape and dimensions, and temperature at control points depending on time have been obtained. Experimental results have clearly shown the effect of the heating catheter, the second cryoprobe, and the initial temperature of the biotissue phantom on the freezing zone. After, the thermal aspects of treatment simulation have been developed and verified. A series of calculations have been carried out with the goal to get the information about optimizing the prostate cryoablation on the prostate-urethra boundary. The arrangement of cryoprobes has been proposed for three different variants for prostate cryoablation (sectors of 90, 180° and 360°). The area of prostate tissues near the urethra that cannot be cooled below the necrosis temperature is shown. This information is expected to be useful for improving the quality of cryosurgery planning algorithms (e.g. for tumor treatment).
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Affiliation(s)
- A V Pushkarev
- Bauman Moscow State Technical University, Moscow, Russia; Russian Medical Academy of Continuous Professional Education, Moscow, Russia.
| | - S S Ryabikin
- Bauman Moscow State Technical University, Moscow, Russia
| | - N Yu Saakyan
- Bauman Moscow State Technical University, Moscow, Russia
| | - D I Tsiganov
- Bauman Moscow State Technical University, Moscow, Russia; Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - I A Burkov
- Bauman Moscow State Technical University, Moscow, Russia
| | - A O Vasilev
- Bauman Moscow State Technical University, Moscow, Russia; Department of Urology, Moscow State University of Medicine and Dentistry n.a. A.I. Evdokimov, Moscow, Russia
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2
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Condino S, Cutolo F, Cattari N, Colangeli S, Parchi PD, Piazza R, Ruinato AD, Capanna R, Ferrari V. Hybrid Simulation and Planning Platform for Cryosurgery with Microsoft HoloLens. SENSORS 2021; 21:s21134450. [PMID: 34209748 PMCID: PMC8272062 DOI: 10.3390/s21134450] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 11/16/2022]
Abstract
Cryosurgery is a technique of growing popularity involving tissue ablation under controlled freezing. Technological advancement of devices along with surgical technique improvements have turned cryosurgery from an experimental to an established option for treating several diseases. However, cryosurgery is still limited by inaccurate planning based primarily on 2D visualization of the patient’s preoperative images. Several works have been aimed at modelling cryoablation through heat transfer simulations; however, most software applications do not meet some key requirements for clinical routine use, such as high computational speed and user-friendliness. This work aims to develop an intuitive platform for anatomical understanding and pre-operative planning by integrating the information content of radiological images and cryoprobe specifications either in a 3D virtual environment (desktop application) or in a hybrid simulator, which exploits the potential of the 3D printing and augmented reality functionalities of Microsoft HoloLens. The proposed platform was preliminarily validated for the retrospective planning/simulation of two surgical cases. Results suggest that the platform is easy and quick to learn and could be used in clinical practice to improve anatomical understanding, to make surgical planning easier than the traditional method, and to strengthen the memorization of surgical planning.
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Affiliation(s)
- Sara Condino
- Information Engineering Department, University of Pisa, 56126 Pisa, Italy; (F.C.); (V.F.)
- Correspondence:
| | - Fabrizio Cutolo
- Information Engineering Department, University of Pisa, 56126 Pisa, Italy; (F.C.); (V.F.)
| | - Nadia Cattari
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (N.C.); (R.P.); (A.D.R.)
| | - Simone Colangeli
- Orthopaedic and Traumatology Division, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, 56124 Pisa, Italy; (S.C.); (P.D.P.); (R.C.)
| | - Paolo Domenico Parchi
- Orthopaedic and Traumatology Division, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, 56124 Pisa, Italy; (S.C.); (P.D.P.); (R.C.)
| | - Roberta Piazza
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (N.C.); (R.P.); (A.D.R.)
| | - Alfio Damiano Ruinato
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (N.C.); (R.P.); (A.D.R.)
| | - Rodolfo Capanna
- Orthopaedic and Traumatology Division, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, 56124 Pisa, Italy; (S.C.); (P.D.P.); (R.C.)
| | - Vincenzo Ferrari
- Information Engineering Department, University of Pisa, 56126 Pisa, Italy; (F.C.); (V.F.)
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Tokiwa T, Zimin L, Ishiguro H, Inoue T, Kajigaya H, Nomura S, Suzuki M, Yamakawa T. A Palm-Sized Cryoprobe System With a Built-In Thermocouple and Its Application in an Animal Model of Epilepsy. IEEE Trans Biomed Eng 2019; 66:3168-3175. [PMID: 30802847 DOI: 10.1109/tbme.2019.2901530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The purpose of this study is to propose a palm-sized cryoprobe system with a built-in thermocouple (TC) for highly accurate and sensitive temperature measurements, and to verify the effectiveness of the system. METHODS Conventional cryoprobe systems based on the boiling effect of a refrigerant have triple coaxial tubes. In the proposed system, the outer and middle coaxial tubes are made of two different metals that are welded only at the probe tip, thereby forming a TC. The thermoelectric properties of the built-in TC and measurement accuracy were investigated in agar in a constant-temperature chamber. The system was also applied in a penicillin G-induced rat brain epilepsy model. RESULTS We verified that the built-in TC has appropriate thermoelectric properties and that the system more accurately and sensitively measured transient temperature changes at the probe tip wall compared to conventional systems, showing the cooling performance of the system. In the rat model, epileptiform activities disappeared on freezing, and reliable cell necrosis was achieved at an end temperature of -45.2 ± 1.6 °C. CONCLUSIONS The proposed system is suitable for reliable cryosurgery. SIGNIFICANCE The system is probably to be valuable for clarifying the relationship between freezing temperature and cell necrosis in vivo.
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Baust JM, Rabin Y, Polascik TJ, Santucci KL, Snyder KK, Van Buskirk RG, Baust JG. Defeating Cancers' Adaptive Defensive Strategies Using Thermal Therapies: Examining Cancer's Therapeutic Resistance, Ablative, and Computational Modeling Strategies as a means for Improving Therapeutic Outcome. Technol Cancer Res Treat 2018; 17:1533033818762207. [PMID: 29566612 PMCID: PMC5871056 DOI: 10.1177/1533033818762207] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Diverse thermal ablative therapies are currently in use for the treatment of cancer. Commonly applied with the intent to cure, these ablative therapies are providing promising success rates similar to and often exceeding "gold standard" approaches. Cancer-curing prospects may be enhanced by deeper understanding of thermal effects on cancer cells and the hosting tissue, including the molecular mechanisms of cancer cell mutations, which enable resistance to therapy. Furthermore, thermal ablative therapies may benefit from recent developments in computer hardware and computation tools for planning, monitoring, visualization, and education. METHODS Recent discoveries in cancer cell resistance to destruction by apoptosis, autophagy, and necrosis are now providing an understanding of the strategies used by cancer cells to avoid destruction by immunologic surveillance. Further, these discoveries are now providing insight into the success of the diverse types of ablative therapies utilized in the clinical arena today and into how they directly and indirectly overcome many of the cancers' defensive strategies. Additionally, the manner in which minimally invasive thermal therapy is enabled by imaging, which facilitates anatomical features reconstruction, insertion guidance of thermal probes, and strategic placement of thermal sensors, plays a critical role in the delivery of effective ablative treatment. RESULTS The thermal techniques discussed include radiofrequency, microwave, high-intensity focused ultrasound, laser, and cryosurgery. Also discussed is the development of thermal adjunctive therapies-the combination of drug and thermal treatments-which provide new and more effective combinatorial physical and molecular-based approaches for treating various cancers. Finally, advanced computational and planning tools are also discussed. CONCLUSION This review lays out the various molecular adaptive mechanisms-the hallmarks of cancer-responsible for therapeutic resistance, on one hand, and how various ablative therapies, including both heating- and freezing-based strategies, overcome many of cancer's defenses, on the other hand, thereby enhancing the potential for curative approaches for various cancers.
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Affiliation(s)
- John M Baust
- 1 CPSI Biotech, Owego, NY, USA.,2 Institute of Biomedical Technology, State University of New York at Binghamton, Binghamton, NY, USA
| | - Yoed Rabin
- 3 Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Thomas J Polascik
- 4 Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Kimberly L Santucci
- 1 CPSI Biotech, Owego, NY, USA.,2 Institute of Biomedical Technology, State University of New York at Binghamton, Binghamton, NY, USA
| | - Kristi K Snyder
- 1 CPSI Biotech, Owego, NY, USA.,2 Institute of Biomedical Technology, State University of New York at Binghamton, Binghamton, NY, USA
| | - Robert G Van Buskirk
- 1 CPSI Biotech, Owego, NY, USA.,2 Institute of Biomedical Technology, State University of New York at Binghamton, Binghamton, NY, USA.,5 Department of Biological Sciences, Binghamton University, Binghamton, NY, USA
| | - John G Baust
- 2 Institute of Biomedical Technology, State University of New York at Binghamton, Binghamton, NY, USA.,5 Department of Biological Sciences, Binghamton University, Binghamton, NY, USA
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Joshi P, Sehrawat A, Rabin Y. The role of exposure time in computerized training of prostate cryosurgery: performance comparison of surgical residents with engineering students. Int J Comput Assist Radiol Surg 2018; 13:541-549. [PMID: 29396685 DOI: 10.1007/s11548-017-1700-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 12/22/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE This study aims at the evaluation of a prototype of a computerized trainer for cryosurgery-the controlled destruction of cancer tumors by freezing. The hypothesis in this study is that computer-based cryosurgery training for an optimal cryoprobe layout is essentially a matter of exposure time, rather than trainee background or the specific computer-generated planning target. Key geometric features under considerations are associated with spatial limitations on cryoprobes placement and the match between the resulted thermal field and the unique anatomy of the prostate. METHODS All experiments in this study were performed on the cryosurgery trainer-a prototype platform for computerized cryosurgery training, which has been presented previously. Among its key features, the cryosurgery trainer displays the prostate shape and its contours and provides a distance measurement tool on demand, in order to address spatial constraints during ultrasound imaging guidance. Another unique feature of the cryosurgery trainer is an output movie, displaying the simulated thermal field at the end of the cryoprocedure. RESULTS The current study was performed on graduate engineering students having no formal background in medicine, and the results were benchmarked against data obtained on surgical residents having no experience with cryosurgery. Despite fundamental differences in background and experience, neither group displayed superior performance when it comes to cryoprobe layout planning. CONCLUSIONS This study demonstrates that computer-based training of an optimal cryoprobe layout is feasible. This study demonstrates that the training quality is essentially related to the training exposure time, rather than to a specific planning strategy from those investigated.
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Affiliation(s)
- Purva Joshi
- Department of Mechanical Engineering, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, 15213, USA
| | - Anjali Sehrawat
- Department of Mechanical Engineering, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, 15213, USA
| | - Yoed Rabin
- Department of Mechanical Engineering, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, 15213, USA.
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