a schematic representation of the handheld electronic cryoprobe 10 is shown in fig1 . cryoprobe 10 is used in conjunction with a disposable application or probe tip 12 . probe tip 12 can be of varying sizes , shapes and lengths , and has a biocompatible treatment surface in thermal contact with the distal end 17 of heat pipe 16 . a handle 14 is provided to facilitate use of probe 10 by the physician . in general , cryoprobe 10 is reusable , since tip 12 is the only component which is disposable . in general , probe 10 may include a number of different handle and tip configurations to tailor the probe to a particular surgical procedure and / or the preference of a particular physician . for this reason , tip 12 and handle 14 are shown in schematic form . the disposable probe tip 12 can contain thermoelectric and / or heat pipe materials , and is used as a trim cooler / heater to give fine temperature or control during the surgical procedure . a sterile sleeve ( not shown ) can be attached in the configuration so that it will slide over the heat pipe extension when installed . a quick snap - on connection ( not shown ) automatically makes power and thermocouple leads . heat pipe extensions can also be quick - connected to the main power thermoelectrics in the handle ( not shown ), and contain power and thermocouple extension wiring for controlling the tip 12 . the proximal end 19 of heat pipe 16 is attached to peltier effect thermoelectric cooling modules 18 . proximal cooling modules 18 draw heat from tip 12 and rejects it into a heat exchanger system depicted at 20 . a liquid coolant such as tap or chilled water may be circulated through appropriate tubing 22 , 23 to transfer heat from cryoprobe 10 to the remote heat exchanger 20 which in turn rejects the heat into the environment . tubing 22 , 23 may be made , for instance , of any well known plastic material , and may be insulated . alternatively , to get the heat from the thermoelectrics in handle 14 to the remote heat exchanger 20 , it is possible to use a circulating liquid system where supply and return liquid channels and wiring are contained within one tube ( not shown ). this tube will have a closed cell insulation extruded over the channels , with an outer protective sheath , such as silicone . heat pipe 16 is of a typical heat pipe construction known in the industry , as described above , having a closed thin wall tube with its inner wall covered with a capillary wick composed of several layers of fine material such as mesh screen , sintered metal wool , or powdered metal . preferably , heat pipe 16 and thermoelectric modules 18 are vacuum insulated . heat pipe 16 is evacuated and a volatile fluid , such as ammonia , is metered into the tube to a proper vapor pressure . cryogenic heat pipe 16 has a condenser end 19 and an evaporator end 17 . the condenser end 19 is cooled , and the gas condenses . the condensed liquid is absorbed by the wick and flows via capillary action to the evaporator end 17 . as heat is applied to the evaporator end 17 , some of the liquid evaporates to a gaseous state . high efficiency is achieved through the phase change of the liquid to its gaseous state . this gas travels at near sonic speeds through the hollow center to the cooled condenser end 19 where it gives up its heat . the gas recondenses and starts the cycle again through the wick . thus , the heat pipe is a closed cycle refrigerator which has no moving mechanical parts , and is powered externally by the thermoelectric materials . thermoelectric cooling modules 18 are essentially a multi - stage thermoelectric heat pump assembly containing numerous cascaded n - type semiconductors and p - type semiconductors well known in the art . electrons in the n - type semiconductors and holes in the p - type semiconductors move heat from the cool body to a heat sink where the heat is removed . a control unit 24 is provided to manage the power requirements of the system . control unit 24 supplies power through a connection 26 to control the circulation of coolant in heat exchanger 20 . control unit 24 also provides electrical power to the proximal thermoelectric modules 18 through a connection 28 . control unit 24 may be programmed to cycle the power to the thermoelectric modules 18 . connection 26 and connection 28 can be any connection commonly used in the industry . in general , the amount of d . c . voltage supplied to thermoelectric modules 18 controls the heat transfer rate of the module because heat moves through the n and p - doped semiconductor relative to the current flow , which in turn varies with voltage application . in operation , feedback sensors may be located at the tissue treatment site to provide temperature information to control unit 24 which is used to cycle power to the thermoelectric modules 18 . in the fig1 embodiment , temperature feedback is provided from the treatment site by a remote sensor 13 which is integrated into disposable treatment tip 12 . in general , one sensor 13 is sufficient on tip 12 , although more may be utilized . remote hypodermic thermocouple probes located in the tissue being frozen may also be used to provide the temperature feedback information . as shown in fig1 temperature data from the treatment site is supplied to the control module 24 through a connection 15 . connection 15 can be any connection commonly used in the industry . with respect to the fig1 embodiment , the temperature cycling of the tissue is accomplished by power regulation of proximal cooler 18 , and is mediated by heat pipe 16 and the passive treatment tip 12 . it should also be understood that a thermoelectric device itself can be operated as a temperature sensor . in embodiments where a distal peltier effect thermoelectric tip cooler module 30 , 30a is located proximate the treatment site , the thermoelectric tip module 30 , 30a can be operated to provide temperature feedback information by their respective current flows , since current flow in thermoelectric materials is directly related to their temperature . this configuration is shown in the embodiment depicted in fig2 and fig3 . fig2 a sets forth a cross - section view of thermoelectric tip cooler module 30 . tip module 30 is made of p and n semiconductor couples 50 positioned between voids 56 which are filled with a thermally conductive material , such as thermally conductive epoxy . insulating ceramic 60 , such as aluminum oxide , sandwiches the p and n couples 50 and the voids 56 filled with conductive material . with respect to the fig2 or fig3 embodiment , the battery of proximal thermoelectric modules 18 provides powerful cooling , reducing the temperature of the treatment site to that needed for the surgical procedure . at this point , a distal or thermoelectric tip cooler 30 , 30a , powered by control unit 24 , may selectively cool or heat the treatment site to provoke a designed or specified freeze / thaw cycle , thus promoting damage to the tissue by controlling the rate of water / ice or ice / water phase change . the distal or tip thermoelectric 30 , 30a , which can work as a cooler or heater by switching the voltage polarity from the dc power supply , serves to fine tune the temperature at the treatment site into a very accurate range , or a designed freeze / thaw cycle . in addition , distal or thermoelectric tip 30 , 30a is utilized to control the freeze / thaw rate . the apparatus shown in fig3 includes a bifurcated thermoelectric tip module 30a having two concentric zones . each zone is separately operated so it can be heated or cooled . when bifurcated thermoelectric module 30a has both zones in a cooling mode , an ice ball 36 will form , as shown in fig5 . each of the zones may be operated separately so that the co - central zone 31 may be operated as a heater while the adjacent annulus 32 may be operated as a cooler , or vice versa , to freeze or thaw the tissue within ice bolus 36 . in fig2 and fig3 proximal cascade thermoelectric module 18 is coupled to the treatment site through a heat pipe which connects to disposable thermoelectric tip module 30 , 30a at the distal end 17 of heat pipe 16 . feedback information in fig2 and fig3 is supplied to control unit 24 by connection 15 , as discussed above . the preferred treatment modality using the fig1 or 2 apparatus is depicted in fig4 a . the preferred treatment modality using the fig3 apparatus is depicted in fig5 . the preferred treatment modality using a heat pipe tip with a resistance heater is shown in fig5 a . the temperature - time history diagrams of fig6 a and 7 are applicable to , and may be generated by any of the above treatment modalities . fig4 illustrates the existing procedure where a treatment probe tip 12 is in contact with tissue 34 surface at a treatment site . compressed cryogen gas is sprayed on the inside of hollow probe tip 12 . as probe tip 12 is placed in contact with the tissue 34 surface , the expanding cryogen gas cools probe tip 12 to the desired operating temperature , such that an ice ball 36 is formed at and below the surface of tissue 34 . ideally , probe tip 12 is positioned so that the ice ball or bolus 36 which forms includes or encompasses the target , abnormal tissue or lesion 38 and a small amount of normal tissue 34 . after the cryoprobe 10 is removed , ice ball 36 begins to quickly thaw from the inside to the exterior . fig4 a illustrates heat pipe 16 with tip 12 in contact with the tissue 34 surface . as electricity is supplied to the proximal cooler 18 , heat pipe 16 is lowered to operating temperatures of about - 70 ° c . tip 12 on heat pipe 16 is positioned on the surface of tissue 34 . as the tissue temperature decreases , ice ball or bolus 36 forms , so as to surround and encompass the target , abnormal tissue 38 and a small amount of normal tissue 34 . after heat pipe 16 power is reduced , ice ball 36 begins to slowly thaw from the interior to the exterior . probe 10 is operated to selectively thaw that portion of ice bolus 36 which is adjacent probe tip 12 . selective thawing of bolus 36 is achieved by reduction of cooling power supplied to probe 10 . the power level supplied to probe 10 can be varied to prevent ice bolus 36 from completely thawing . temperature feedback can be used to control the delivery of power to the probe 10 to provide the alternating freeze and thaw cycles , or the power level can be preprogrammed to follow a preset power delivery protocol . fig5 illustrates an ice ball 36 formed when the bifurcated thermoelectric tip cooler module 30a shown in fig3 has both zones in the cooling mode . after the initial ice ball or bolus 36 is formed , the co - central zone 31 can be switched to a heating mode while keeping the adjacent annulus zone 32 in a cooling mode . by this technique , the target abnormal tissue or lesion 38 can be brought to a metabolizing temperature while the outer wall of bolus 36 remains substantially frozen . target tissue 38 , as it is warmed , comprises water and water metabolizing stored nutrients . ice in ice ball 36 is approximately four times as heat conductive as the liquid water in tissue 38 . thus , the outer cooled zone 37 surrounding target tissue 38 maintains the nutrient blocking ice shield . alternatively , as shown in fig5 a , a heat pipe 16 tip 12 can include a thin film heater 35 ( made from an etched - foil resistive element laminated between layers of insulating film of the tip 12 such as thermofoil ™ manufactured by minco products , inc .). thin film heater 35 performs the same function as inner thermoelectric zone 31 shown in fig5 . heat pipe conduction 39 performs the same function as outer thermoelectric zone 32 in fig5 . thus , thin film heater 35 can be used in a heating mode while heat pipe conduction 39 remains in a cooling mode so that target , abnormal tissue 38 can be brought to a metabolizing temperature , while the outer wall of bolus 36 remains substantially frozen , insulating the surrounding tissue from nutrient supply . the apparatus of the present invention may also be used to provoke multiple freeze - thaw phase changes in the treated tissue which are generated by selectively regulating the voltage delivered to the thermoelectric cooling modules . such regulation can be accomplished by selectively increasing and decreasing the voltage delivered to the thermoelectric cooling modules 30 , 30a to cool the treated tissue , followed by reversing the polarity of the voltage delivered to the thermoelectric cooling modules 30 , 30a to warm the treated tissue . it should be further understood that the freeze - thaw phase changes can be generated by regulating the voltage delivered to either one or both of the thermoelectric cooling modules 18 , 30 , 30a . in addition , the precise regulation of the phase changes may be accomplished through the use of a control and temperature sensor feedback system , where an embedded hypodermic thermocouple transmits temperature information to a microprocessor which monitors the rate of temperature change relative to time , thus detecting the phase change . the microprocessor then applies power to the thermoelectric modules so as to extend the phase change time , thereby causing maximum ice crystal growth . this type of control is known commonly in industrial process control as pid ( proportional , integral , derivative ) control . finally , when both thermoelectric modules 30 / 30a and proximal thermoelectric cooling modules 18 are utilized , freeze - thaw cycling may be accomplished by holding the thermoelectric cooling modules 30 / 30a at a constant , near - freezing temperature , while regulating the voltage delivered to the proximal cooling module 18 . multiple controlled ramp rates may be replaced in the above manner thus insuring complete tissue destruction in a single treatment . the time / temperature histories more fully describe this operation . in fig6 the temperature profile 40 shows the temperature history of the surface being contacted by a liquid cryogen while profile 42 shows the temperature profile a short distance inside the tissue treatment site . at point a in profile 42 , the tissue is at ambient temperature . the direct application of a liquid cryogen or hollow closed end tube being cooled by direct spray of a cryogen produces a steep drop in temperature in the tissue until it is removed as indicated at low point b . the tissue undergoes a natural thaw returning the temperature to ambient at point d . the inflection of the temperature time history at c , reflects the relatively rapid phase change from the solid to liquid phase . some ice crystal elongation does develop during the thaw , normally not enough to assure effectiveness , for this reason normal procedures call for a second application after the thaw when treating cancer lesions . additionally the freeze rate is so rapid that no phase change inflection can be detected during the temperature drop , thereby resulting in less damaging , very small ice crystals . these procedures depend on ice crystal growth solely during thaw to produce damage . in contrast to the direct application of liquid cryogens , fig6 a shows the time vs . temperature histories of the thermoelectrically powered probe . the temperature profile 40 shows the temperature history of the probe tip while 42 once again shows that temperature a short distance inside the tissue treatment site . at point a in profile 42 , the tissue is at ambient temperature . the application of power to the thermoelectric modules 18 results in cooling the tissue below the freezing point , to a low temperature designated as b , in fig6 . the temperature drop is created by multi - stage thermoelectrics in the handle of the probe 10 , and heat is extracted from the condenser end of the heat pipe . the evaporator end of heat pipe 16 is placed against target tissue 38 where it removes body heat at a rate shown by profile 42 . at this point , the electrical power to the thermoelectric modules 18 is turned off or reduced , and tissue 38 undergoes a warming cycle , returning the temperature of the tissue to ambient at d . in general , this temperature vs . time history emulates the application of a prior art liquid refrigerant directly on the tissue as shown in fig6 . however , in contrast to the prior art , the rate at which the tissue is frozen is a feedback controlled function with an extended phase change induced during the freeze portion of the cycle . in a similar fashion the b to d transition can be controlled as well , and the phase change time during the thaw cycle can be extended . control over the solid to liquid phase transition can be used to maximize the amount of tissue damage resulting from the ice crystal growth and elongation invoked by the controlled slow thaw cycle . direct application of the thermoelectric modules can achieve temperatures in the range of - 25 ° c . however , the addition of heat pipe 16 improves the ability of the surgeon to manipulate the cryoprobe device 10 and allows the use of the larger thermoelectric modules needed for the colder temperatures and proper depth of freeze . in addition , use of the heat pipe 16 provides a means to reach into cavities . heat pipe 16 can also be made flexible by using many thin walled microbore tubes in its construction to provide the gas and liquid transport areas of the pipe between the condenser and evaporator tip . fig7 is a graphical illustration of the preferred multiple freeze - thaw phase changes that occur in treated tissue over time as a result of cycled application of cryogenic temperatures when a thermoelectric application tip 30 is added to the electronic cryoprobe 10 of the present invention . in operation , the initial temperature of the tissue at a is at or above room temperature . the multistage thermoelectric module 18 , attached to the heat pipe 16 condenser end , drops the temperature initially to a less cold level b . thermoelectric tip 30 , or 30a added to the cold end of heat pipe 16 is applied to the site being treated , and heat is extracted or added as required to accomplish the tissue freeze / thaw procedure , shown at b , c , d , e , f , g , h and i in fig7 . very accurate and quick temperature changes can be pre - programmed using an embedded microprocessor to accomplish a positive procedure . with the coldest temperatures being generated at tip 30 or 30a , probe 10 may be inserted into more restricted and deeper cavities without the chance of damaging normal wall tissue . as can be appreciated , use of cryoprobe 10 using a bifurcated thermoelectric tip cooler module 30a creates an ice shield which prevents the flow of nutrients resulting from the thaw of tissue 38 , thereby ensuring cell starvation . a hand - held cryoprobe 10 eliminates the need for compressed gases , while giving the physician positive control . in addition , because solid state electronics lends itself to miniaturization , cryosurgical devices will have many uses , including possible use with endoscopes . while the invention has been described in detail with particular reference to the drawings and illustrative embodiment , it should be understood that modifications will be effected within the spirit and scope of the invention .
a thermoelectric cryoprobe for the topical treatment of neoplasms by freezing . the cryoprobe comprises a plurality of stacked thermoelectric modules coupled to a distal treatment tip through a heat pipe . heat is dissipated by a heat exchanger system . an external control unit is provided which serves as a source of dc power for the hand - held cryoprobe and contains a control system for controlling the thermoelectric element based upon temperature feedback from treatment site . temperature feedback from the sensors facilitates freeze - thaw cycling by the cryoprobe to more effectively destroy the tissue at the treatment site .