title: Real-time transrectal ultrasonography-guided hands-free technique for focal cryoablation of the prostate.
abstract: OBJECTIVE
  To describe, step-by-step, our hands-free technique for focal cryoablation of prostate cancer.
  
  
  METHODS
  After detailed discussion of its limitations and benefits, consent was obtained to perform focal cryoablation in patients with biopsy-proven unilateral low- to intermediate-risk prostate cancer. The procedure was performed transperineally, using a hands-free technique (without an external grid template) under real-time bi-plane transrectal ultrasonography (TRUS) guidance, using an argon/helium-gas-based third generation cryoablation system. Follow-up consisted of validated questionnaires, physical examination, PSA measures, multiparametric TRUS and/or magnetic resonance imaging (MRI) and mandatory biopsy.
  
  
  RESULTS
  The important steps for achieving safety, satisfactory oncological and functional outcomes included: patient selection, including TRUS/MRI fusion target biopsy; thermocouple and cryoprobe placement with a hands-free technique, allowing delivery in unrestricted angulations according to the prostatic contour, the course of the neurovascular bundle and the rectal wall angle; and hands-free bi-plane TRUS probe manipulation to facilitate real-time monitoring of anatomical landmarks at the ideal angle of the image plane. To achieve a lethal temperature in the known cancer area, while preserving the urinary sphincter, neurovascular bundle, urethra and rectal wall, continuous intraoperative control of the thermocouple temperatures was necessary, as were real-time TRUS monitoring of ice-ball size, control of the energy delivered and the use of a warming urethral catheter.
  
  
  CONCLUSIONS
  We have described step-by-step the focal cryoablation of prostate cancer using a hands-free technique. This technique facilitates the effective delivery of cryoprobes and the intra-operative real-time quick manipulation of the TRUS probe.
authors.affiliation: USC Institute of Urology, Catherine and Joseph Aresty Department of Urology, Center for Prostate Cancer Focal Therapy, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Andre Luis
authors.initials: AL
authors.lastname: de Castro Abreu
authors.forename: Duke
authors.initials: D
authors.lastname: Bahn
authors.forename: Sameer
authors.initials: S
authors.lastname: Chopra
authors.forename: Scott
authors.initials: S
authors.lastname: Leslie
authors.forename: Toru
authors.initials: T
authors.lastname: Matsugasumi
authors.forename: Inderbir S
authors.initials: IS
authors.lastname: Gill
authors.forename: Osamu
authors.initials: O
authors.lastname: Ukimura
mesh_terms: D003452:Cryosurgery / Q000379:methods*; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000000981:diagnostic imaging*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014463:Ultrasonography
keywords: cryoablation; focal therapy; hands-free cryoablation; prostate cancer