Infant and Child European Cryoablation Project ICECaP

Cryoablation involves image-guided insertion of single-use specialised needles or probes through the skin into a soft tissue or bone lesion. A mechanised unit is connected to the probe(s) and generates cyclical freezing and thawing of the tissues at the probe tip(s) via exchange of highly pressurised gases through the probe lumen(s), utilising the Joules-Thomson effect. Extreme freezing and thawing of the lesion causes permanent tissue destruction through both mechanical disruption of tissue membranes and a secondary immune response effect.

Cryoablation is one of several minimally invasive ablative techniques used to reduce the size of or to eradicate soft tissue and bone lesions. Ablative techniques are now an accepted standard of care for many benign and malignant lesions in adult practice. Cryoablation is widely used in the management of renal cell carcinoma, with medium-term outcomes matching surgical resection.

The advantages of cryoablation over surgery, particularly in a paediatric population, are:

• Minimally invasive approach, therefore suitable for day case procedures and almost scarless
• Significantly faster recovery times compared to complex surgical debulking
• Minimal complication rates compared to surgery (less risk to nerves, blood vessels and critical solid organ)
• Affords excellent pain relief (has an independent role in chronic pain management)

To date the use of cryoablation in children remains novel and under reported.