Percutaneous cryoablation of small pulmonary malignant tumors under computed tomographic guidance with local anesthesia for nonsurgical candidates  Masafumi Kawamura, MD, Yotaro Izumi, MD, Norimasa Tsukada, MD, Keisuke Asakura, MD, Hiroaki Sugiura, MD, Hideki Yashiro, MD, Keiko Nakano, MD, Seishi Nakatsuka, MD, Sachio Kuribayashi, MD, Koichi Kobayashi, MD  The Journal of Thoracic and Cardiovascular Surgery  Volume 131, Issue 5, Pages 1007-1013 (May 2006) DOI: 10.1016/j.jtcvs.2005.12.051 Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Two cryoprobes are inserted under computed tomographic (CT) guidance. CT scans can be taken as needed during the cryoablation procedure. The Journal of Thoracic and Cardiovascular Surgery 2006 131, 1007-1013DOI: (10.1016/j.jtcvs.2005.12.051) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Sequential changes of the pulmonary parenchyma on computed tomographic scanning after freezing and thawing. 1, The metastatic tumor is located in right S4. 2, The cryoprobe penetrates the tumor. 3, Five minutes after the beginning of first freezing, the change of surrounding lung is quite small. 4, After first thawing, consolidation along the cryoprobe can be seen. 5, Five minutes after the beginning of second freezing, extension of the consolidated area can be seen. 6, After third thawing. The Journal of Thoracic and Cardiovascular Surgery 2006 131, 1007-1013DOI: (10.1016/j.jtcvs.2005.12.051) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Accumulated survival curve by means of the Kaplan-Meier method. The Journal of Thoracic and Cardiovascular Surgery 2006 131, 1007-1013DOI: (10.1016/j.jtcvs.2005.12.051) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Cryoprobe can approach to the hilar lesions. A case with 6 peripheral and 1 central metastases: 6 peripheral metastases had been resected surgically. A centrally located tumor is shown in a 3-dimensional computed tomographic image. Two cryoprobes are inserted into the lung. Because the tumor was located close to a large vessel, 2 probes are inserted almost parallel, like chopsticks, so as to encase the tumor. This avoids vessel and airway damage, and preserves pulmonary function. The Journal of Thoracic and Cardiovascular Surgery 2006 131, 1007-1013DOI: (10.1016/j.jtcvs.2005.12.051) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions