Models and Mechanisms of Tissue Injury in Cryosurgery

Cryotherapies are used for the management of pain and inflammation, the ablation of neoplastic lesions, and the removal of diseased or damaged tissues. This chapter discusses types of injuries: hypothermic injury, freezing injury, thawing injury, and post-thaw injury. A number of culture models are available for the study of cryosurgical procedures and cellular responses to low temperatures, including acellular hydrogels, monolayer cultures, animal models, tissue-engineered constructs, and clinical studies. The identification of biochemical and immunological cell death in the periphery of the cryolesion has afforded the opportunity to attenuate the freeze margin through the use of adjuvants or adjunctive therapies. Advances in cryosurgical technologies are aiming to make cryosurgery colder, faster, and more destructive, potentially expanding its application to even more diverse tissues and disease states. Studies into the phenomenon of cryoimmunity hold tremendous value as the possibility of systemic benefit from localized treatments could drastically alter cancer treatments.