Abstract: Devices and methods for cooling vessel walls to inhibit restenosis in conjunction with medical procedures such as coronary artery angioplasty. Stenosed vessel walls can be cooled prior to angioplasty, after angioplasty, or both. The invention is believed to inhibit restenosis through cooling to a temperature near freezing, preferably without causing substantial vessel wall cell death. One catheter device includes a distal tube region having coolant delivery holes radially and longitudinally distributed along the distal region. In some devices, holes spray coolant directly onto the vessel walls, with the coolant absorbed into the blood stream. In other embodiments, a balloon or envelope is interposed between the coolant and the vessel walls and the coolant returned out of the catheter through a coolant return lumen. Some direct spray devices include an occlusion device to restrict blood flow past the region being cooled. Pressure, temperature, and ultrasonic probes are included in some cooling catheters.

Abstract: A catheter is adapted to exchange heat with a body fluid, such as blood, flowing in a body conduit, such as a blood vessel. The catheter includes a shaft with a heat exchange region disposed at its distal end. This region may include hollow fibers which are adapted to receive a remotely cooled heat exchange fluid preferably flowing in a direction counter to that of the body fluid. The hollow fibers enhance the surface area of contact, as well as the mixing of both the heat exchange fluid and the body fluid. The catheter can be positioned to produce hypothermia in a selective area of the body or alternatively positioned to systemically cool the entire body system.

Abstract: Stabilizing an object in the body of a patient involves the injection of a lower critical solution temperature (LCST) material or other flowable material into the body of the patient so that the material contacts the object. The LCST material or other flowable material then forms a gel in the body such that the object is contained at least partially within the gel and thereby stabilized by the gel such that the object can then be easily fragmented within the body and/or retrieved from the body.

Abstract: A system and method for controlling the inflation, ablation, and deflation of a balloon catheter. The system includes a balloon catheter, a console, a pressurized gas or liquid inflation source, and an umbilical system to deliver pressurized coolant to the balloon catheter. The system may include controller that monitors the amount of pressure and volume within the balloon catheter. During inflation, the pressure and/or volume of fluid within the balloon is maintained at a target amount in order to provide sufficient mechanized pressure against the desired target region. The system limits the inflation pressure such that a safe quantity of gas would be released should a leak occur. If the amount falls below a certain threshold level, gas or fluid egress is presumed and the inflation process is halted.

Abstract: A device for treating esophageal target tissue comprises a catheter, a balloon and a refrigerant delivery device. The catheter has a distal portion and a refrigerant delivery lumen. The balloon is mounted to and the refrigerant delivery device is coupled to the distal portion. The refrigerant delivery device comprises a chamber with the refrigerant delivery lumen opening into the chamber, a refrigerant delivery opening fluidly coupled to the balloon interior, and a distribution passageway fluidly coupling the chamber and the refrigerant delivery opening. A refrigerant is deliverable through the refrigerant delivery lumen, into the chamber, through the distribution passageway, through the refrigerant delivery opening and into the balloon interior so to place the balloon into an expanded, cooled state so that the balloon can press against and cool esophageal target tissue. The medical device may include means for sensing a leak in the balloon.

Abstract: A device and method for safely securing a multilumen device to a tissue, organ or solid tumor within the body of a human during a diagnostic or therapeutic procedure is described. The device is capable of securing the tumor by touching or piercing its surface and providing a coolant to the distal tip. Cooling the tip forms a cryogenically induced region that tightly binds the tip to the tumor, temporarily sealing the entry-track of the instrument. The device further provides at least one injecting/aspirating lumen that can dispense or aspirate a fluid within the tumor. Such construction allows injecting part or whole volume of the tumor while the cryogenically induced bond prevents back-flow of the injected substances through the entry-track.

Abstract: Stabilizing an object in the body of a patient involves the injection of a lower critical solution temperature (LCST) material or other flowable material into the body of the patient so that the material contacts the object. The LCST material or other flowable material then forms a gel in the body such that the object is contained at least partially within the gel and thereby stabilized by the gel such that the object can then be easily fragmented within the body and/or retrieved from the body.

Abstract: A cryogenic medical system includes a medical device and a console connectable to the medical device at a connection point. The console controls the temperature of the medical device. The console includes a first cooling system directing coolant to the medical device at a first temperature along a coolant supply line and a second cooling system chilling the coolant within the coolant supply line to a temperature below the first temperature before the coolant reaches the connection point.

Abstract: An electromagnetic surgical ablation probe having a conical hood reflector and method of manufacture thereof is disclosed. The disclosed probe includes a shaft assembly that has a coaxial feedline core having an inner conductor and an outer conductor separated by an insulating layer. A tubular catheter is disposed coaxially around the feedline and is configured to deliver coolant, such as saline or deionized water, to a coolant chamber at a distal end formed within the conical reflector. A radiating section disposed within the conical reflector may have a conical, cylindrical, or other suitable shape. A membrane disposed across a distal opening of the conical reflector seals coolant within the coolant chamber, and may conform to tissue contours during use. A resilient aperture may be included at the periphery of the conical hood. The shaft assembly may include an angled section, an adjustable section, and, additionally or alternatively, a malleable section.

Abstract: A method and apparatus for creating and accessing an anatomic space between a heart and a pericardial sac. The apparatus includes a catheter having a cryoadhesion member situated on the distal tip of the catheter. The cryoadhesion member is utilized to adhere to the pericardial sac and to retract the sac to create a tent like structure. The catheter allows introduction of an instrument to access the pericardial sac by puncture. The access to the pericardial sac allows delivery of a device, a drug, a biologic or other substance to the heart or the space around the heart.

Abstract: An apparatus for cooling ablation catheters via a coolant pump and liquid cooling medium controlled by a controller based on a characteristic state for an activity of a catheter and in addition a system that uses the apparatus for ablation of tissue in a human or animal body. The system includes an elongated ablation catheter, an ablation generator electrically connected to the catheter to generate a high-frequency energy pulse or a high-frequency energy field, the coolant pump connected to the catheter and the controller and a control line connected to the pump. The control line comprises an electric circuit designed to detect a high-frequency pulse or a high-frequency field.

Abstract: A first trocar as an medical apparatus includes an insertion hole having a projection opening for leading out a biopsy forceps into a body of a subject, a lid body for blocking the projection opening of the insertion hole, and a cooling sheet for cryogenically cooling a biopsy portion arranged in the vicinity of the lid body in a state where the biopsy forceps is stored in the insertion hole, and is capable of easily harvesting a living tissue while retaining morphological change of tissues in a living body under various hemodynamics.

Abstract: Medical devices, systems, and methods for pain management and other applications may apply cooling with at least one probe inserted through an exposed skin surface of skin. The cooling may remodel one or more target tissues so as to effect a desired change in composition of the target tissue and/or a change in its behavior, often to interfere with transmission of pain signals along sensory nerves. Alternative embodiments may interfere with the function of motor nerves, the function of contractile muscles, and/or some other tissue included in the contractile function chain so as to inhibit muscle contraction and thereby alleviate associated pain. In some embodiments, other sources of pain such as components of the spine (optionally including herniated disks) may be treated.

Abstract: An elongated catheter device with a distal balloon assembly is adapted for endovascular insertion. Coolant injected through the device may, in different embodiments, directly cool tissue contacting the balloon, or may cool a separate internal chamber. Plural balloons may be provided, wherein a secondary outer balloon surrounds a primary inner balloon, the primary balloon being filled with coolant and acting as the cooling chamber, the secondary balloon being coupled to a vacuum return lumen to serve as a robust leak containment device and thermal insulator around the cooling chamber. One or more sensors may be disposed between the balloons or the vacuum return lumen, to detect leaks and control the flow of fluid through the device. Examples of sensors include pressure and temperature sensors, optical sensors, magnetic flow switches and flow meters.

Abstract: A method of cryogenically treating a tissue region is provided, including positioning a treatment region of a medical device proximate the tissue region; transferring coolant in a substantially liquid phase from a coolant reservoir to a subcooler; transitioning the coolant from the liquid phase into a supercritical state; transferring the supercritical coolant to the treatment region; changing the coolant from the supercritical state to at least one of a liquid phase and a gaseous phase at the treatment region; ablating the tissue region; and evacuating coolant from the treatment region of the medical device.

Abstract: The invention is a method for using a cryoprobe for cryoablating, thawing and/or cauterizing a tissue during a cryosurgical procedure. An embodiment of the cryosurgical system comprises a controller including a cryoprobe with an electrical heating element. The controller operates the electrical heating element for heating a treatment head of the cryoprobe to a temperature sufficient for cauterizing the tissue in the vicinity of the treatment head. Additionally, the controller regulates a supply of a heating gas and a cooling gas, respectively, for thawing and cryoablating the tissue in the vicinity of the treatment head. The controller is configured for operating a plurality of cryoprobes connected thereto.

Abstract: A method for ablation in which a portion of atrial tissue around the pulmonary veins of the heart is ablated by a first elongated ablation component and a second elongated ablation component movable relative to the first ablation component and having means for magnetically attracting the first and second components toward one another. The magnetic means draw the first and second components toward one another to compress the atrial tissue therebetween, along the length of the first and second components and thereby position the device for ablation of the tissue.

Abstract: Described herein are various methods and devices for delivering cryoablative therapy. One such device includes a cryoablation chamber and a volume displacement chamber. In use, the volume displacement chamber can be expanded to occupy a non-therapeutic volume.

Abstract: The present invention provides a medical device having an elongate body with both a proximal end and a distal end, wherein the elongate body defines an intake lumen and an exhaust lumen. The medical device also has a first pliable element defining a cooling chamber disposed at a point along the elongate body, with the cooling chamber being in fluid communication with the intake lumen and the exhaust lumen. A second pliable element is provided which at least partially encloses the first pliable element, thereby defining a junction between the first and second pliable element. Moreover, a check valve is included which is in fluid communication with the junction between the first pliable element and second pliable element, the valve further being in fluid communication with the exhaust lumen. In addition, the medical device may include sensors or other monitoring means in fluid communication with the junction and the cooling chamber.

Abstract: A cryosurgical instrument for separating a tissue sample from a biological tissue to be treated, for purposes of biopsy. The cryosurgical instrument includes a probe for bringing a probe head up to the biological tissue and a gas line for supplying cooling gas from a gas source of a cryosurgical apparatus to the probe head. The probe head cools a limited tissue region, by means of the supplied gas, for obtaining a tissue sample. The tissue sample can be separated from the surrounding tissue when frozen onto the probe head. The instrument has a support tube in which the probe is guided and which can be moved relative to the probe in such a way that the surrounding tissue can be supported by means of the support tube during the separating of the tissue sample. The instrument also includes an accelerating device that provides a predefined force for the separating process.

Abstract: In one embodiment, the disclosure is directed to an integrated apparatus for delivering energy to a tissue. The integrated apparatus included a housing having a distal end and a tubular structure located within the housing forming a first annulus between the tubular structure and the housing. The tubular structure is configured to accept an energy delivery component and is configured to form a second annulus between the tubular structure and the energy delivery component. The first annulus and the second annulus are configured to communicate with each other proximate to the distal end of the housing.

Abstract: A catheter is adapted to exchange heat with a body fluid, such as blood, flowing in a body conduit, such as a blood vessel. The catheter includes a shaft with a heat exchange region disposed at its distal end. This region may include hollow fibers which are adapted to receive a remotely cooled heat exchange fluid preferably flowing in a direction counter to that of the body fluid. The hollow fibers enhance the surface area of contact, as well as the mixing of both the heat exchange fluid and the body fluid. The catheter can be positioned to produce hypothermia in a selective area of the body or alternatively positioned to systemically cool the entire body system.

Abstract: The present invention provides a medical device having an elongate body with both a proximal end and a distal end, wherein the elongate body defines an intake lumen and an exhaust lumen. The medical device also has a first pliable element defining a cooling chamber disposed at a point along the elongate body, with the cooling chamber being in fluid communication with the intake lumen and the exhaust lumen. A second pliable element is provided which at least partially encloses the first pliable element, thereby defining a junction between the first and second pliable element. Moreover, a check valve is included which is in fluid communication with the junction between the first pliable element and second pliable element, the valve further being in fluid communication with the exhaust lumen. In addition, the medical device may include sensors or other monitoring means in fluid communication with the junction and the cooling chamber.

Abstract: Phacoemulsification apparatus includes a phacoemulsification handpiece having a needle and an electrical circuitry for ultrasonic vibrating the needle. A power source provides pulsed electrical power to the handpiece electrical circuitry and an input is provided for enabling a surgeon to select an amplitude of dislighted pulses and a pulse width. A control system and pulse duty cycle is provided for controlling the off duty cycle to insure heat dissipation before a subsequent pulse is activated, including a foot pedal switch.

Abstract: Neuromodulation cryotherapeutic devices and associated systems and methods are disclosed herein. A cryotherapeutic device configured in accordance with a particular embodiment of the present technology can include an elongated shaft having distal portion and a supply lumen along at least a portion of the shaft. The shaft can be configured to locate the distal portion intravascularly at a treatment site proximate a renal artery or renal ostium. The supply lumen can be configured to receive a liquid refrigerant. The cryotherapeutic device can further include a cooling assembly at the distal portion of the shaft. The cooling assembly can include an applicator in fluid communication with the supply lumen and configured to deliver cryotherapeutic cooling to nerves proximate the target site when the cooling assembly is in a deployed state.

Abstract: Devices, systems, and methods controllably cool blood vessels and other body lumens. The blood vessel will often be treated for atherosclerotic or other diseases by inflating a balloon so as to engage the surrounding luminal wall. Controlled cooling of the balloon effected by a change in phase of a cryogenic fluid within the balloon typically a change from a liquid phase to a gas phase can be provided with a controlled, gradual inflation of the balloon. A single control system can be used for any of a variety of alternative selectable balloon catheters having significantly differing cooling fluid flow characteristics.

Abstract: A cryogenic wand for ablating tissue comprising a cryogenic ablation tube closed at a distal end and including an ablation zone, the ablation tube in fluid communication with and coupled proximally to at least one of two segments that are rotatably repositionable with respect to one another, wherein the two segments are fluidically sealed so that fluid entering a first of the at least two segments passes therethrough and enters a second of the at least two segments.

Abstract: A medical treatment system, including a catheter body defining a fluid flow path therethrough; an expandable element disposed on the catheter body, the expandable element defining a cooling chamber therein in fluid communication with the fluid flow path; a plurality of electrodes disposed on the expandable element; a cryogenic fluid source in fluid communication with the fluid flow path; and a radiofrequency energy source in electrical communication with the plurality of electrodes. A method of treating a cardiac tissue site proximate an orifice, including substantially occluding the orifice with an expandable element; powering a plurality of electrodes coupled to the expandable element to reach a predetermined target temperature; circulating a coolant through the expandable element to freeze portions of the cardiac tissue site located between the plurality of electrodes; and ablating the non-frozen portions of the tissue site with the plurality of electrodes.

Abstract: The present invention relates to methods and devices for carrying out cryogenic therapy, particularly on the whole body of a patient, wherein the patient is exposed to gases cooled to cryogenic temperature. The process is performed by introducing the patient into the interior of a treatment cabin and exposing the body to cold air deposited into the cabin space.

Abstract: The present invention provides an enhanced method and device to inhibit or reduce the rate of restenosis following angioplasty or stent placement. The invention involves placing a balloon tipped catheter in the area treated or opened through balloon angioplasty immediately following angioplasty. The balloon, which can have a dual balloon structure, may be delivered through a guiding catheter and over a guidewire already in place from a balloon angioplasty. A fluid such as a perfluorocarbon may be flowed into the balloon to freeze the tissue adjacent the balloon, this cooling being associated with reduction of restenosis. The catheter may also be used to reduce atrial fibrillation by inserting and inflating the balloon such that an exterior surface of the balloon is in contact with at least a partial circumference of the portion of the pulmonary vein adjacent the left atrium.

Abstract: A cryoprobe with a reliable and inexpensive quick coupling unit including a male unit and a suitable corresponding female coupling unit. The female unit is installed on the distal end of a hose supplying the liquid cryogen into the cryoprobe.

Abstract: As disclosed herein, cryoprobes comprising no return line can be operated efficiently and safely on known supply systems for cryoprobes. Typically the supply systems provide a fluid for connected cryoprobes so that they will provide the desired cooling capacity. The cooling capacity can be adjusted through the supply system. An adapter for connecting a supply system with a cryoprobe for open fluid cooling, wherein the adapter comprises: a first fluid adapter connector for connecting a first supply terminal of the supply system: a second fluid adapter connector for connecting a second supply terminal of the supply system: a feed line output for connecting a feed line of the cryoprobe: a first fluid line for the fluid connection of the first fluid adapter connector with the feed line output: and a second fluid line for the fluid connection of the feed line output with the second fluid adapter connector, wherein the fluid flow in the second fluid line is reduced compared the one in the first fluid line.

Abstract: A catheter is adapted to exchange heat with a body fluid, such as blood, flowing in a body conduit, such as a blood vessel. The catheter includes a shaft with a heat exchange region disposed at its distal end. This region may include hollow fibers which are adapted to receive a remotely cooled heat exchange fluid preferably flowing in a direction counter to that of the body fluid. The hollow fibers enhance the surface area of contact, as well as the mixing of both the heat exchange fluid and the body fluid. The catheter can be positioned to produce hypothermia in a selective area of the body or alternatively positioned to systemically cool the entire body system.

Abstract: A catheter is adapted to exchange heat with a body fluid, such as blood, flowing in a body conduit, such as a blood vessel. The catheter includes a shaft with a heat exchange region disposed at its distal end. This region may include hollow fibers which are adapted to receive a remotely cooled heat exchange fluid preferably flowing in a direction counter to that of the body fluid. The hollow fibers enhance the surface area of contact, as well as the mixing of both the heat exchange fluid and the body fluid. The catheter can be positioned to produce hypothermia in a selective area of the body or alternatively positioned to systemically cool the entire body system.

Abstract: A catheter is adapted to exchange heat with a body fluid, such as blood, flowing in a body conduit, such as a blood vessel. The catheter includes a shaft with a heat exchange region disposed at its distal end. This region may include hollow fibers which are adapted to receive a remotely cooled heat exchange fluid preferably flowing in a direction counter to that of the body fluid. The hollow fibers enhance the surface area of contact, as well as the mixing of both the heat exchange fluid and the body fluid. The catheter can be positioned to produce hypothermia in a selective area of the body or alternatively positioned to systemically cool the entire body system.

Abstract: A catheter is adapted to exchange heat with a body fluid, such as blood, flowing in a body conduit, such as a blood vessel. The catheter includes a shaft with a heat exchange region disposed at its distal end. This region may include hollow fibers which are adapted to receive a remotely cooled heat exchange fluid preferably flowing in a direction counter to that of the body fluid. The hollow fibers enhance the surface area of contact, as well as the mixing of both the heat exchange fluid and the body fluid. The catheter can be positioned to produce hypothermia in a selective area of the body or alternatively positioned to systemically cool the entire body system.

Abstract: A liquid cryogen fluid system for providing cryogenic liquid to a cryoprobe in a cryosurgical system for treating fibroadenomas and other lesions in the body. The system includes a cryoprobe to cryoablate a fibroademona with a treatment regimen that takes less time and consumes less cryogen than currently accepted regimens.

Abstract: A system for selectively cooling and warming a cryosurgical instrument using a dual phase cryogen, including: two sources of the cryogen, a first source storing liquid phase cryogen and having a first source heater therein that selectively converts at least some of the liquid phase cryogen into gaseous phase cryogen and a second source storing the gaseous phase cryogen; a cryogen delivery control section selectively delivering cryogen to the tip; a cryogen return path from the tip to the first and second sources; a cryogen return control section that includes a pump that pumps the returning cryogen to the second source; and a pressure control section including a first pressure sensor that senses a pressure in the first source, a second pressure sensor that senses a pressure in the second source, and a pressure regulator that regulates the pressure of the first source based on information from the pressure sensors.

Abstract: A method for performing cryotherapy on a target tissue region in a body includes positioning a first cooling element in a first location in a body adjacent a target tissue region, positioning a second cooling element in a second location in the body adjacent the target tissue region, and cooling the respective first and second cooling elements so as to cool the target tissue region.

Abstract: A method for tightening and rejuvenating skin utilizing a cryogenic applicator, which includes the steps of holding a handle of a barrel of the cryogenic applicator in a hand, fluidly communicating the barrel with a source of a biocompatible non-toxic cryogenic fluid to supply the biocompatible non-toxic cryogenic fluid through a hollow interior of the barrel, out through a plurality of openings in a distal portion of the barrel, and onto a head of the cryogenic applicator, rolling the head quickly, smoothly, and evenly over the skin being treated for a period of time in an order of hundredths or tenths of a second, and sparging the biocompatible non-toxic cryogenic fluid onto the skin quickly, evenly, and smoothly when the head is rolled on the skin, and thereby tightening and rejuvenating the skin.

Abstract: A cryosurgery apparatus is disclosed. The cryosurgery apparatus an introducer having a hollow and a distal portion, the distal portion being sufficiently sharp so as to penetrate into a body, the hollow of the introducer being designed and constructed for containing a plurality of cryoprobes each of the cryoprobes being for effecting cryoablation, such that each of the plurality of cryoprobes is deployable through the distal portion of the introducer when the distal portion is positioned with respect to a tissue to be cryoablated.

Abstract: The present invention provides an enhanced method and device to inhibit or reduce the rate of restenosis following angioplasty or stent placement. The invention involves placing a balloon tipped catheter in the area treated or opened through balloon angioplasty immediately following angioplasty. The balloon, which can have a dual balloon structure, may be delivered through a guiding catheter and over a guidewire already in place from a balloon angioplasty. A fluid such as a perfluorocarbon may be flowed into the balloon to freeze the tissue adjacent the balloon, this cooling being associated with reduction of restenosis. The catheter may also be used to reduce atrial fibrillation by inserting and inflating the balloon such that an exterior surface of the balloon is in contact with at least a partial circumference of the portion of the pulmonary vein adjacent the left atrium.

Abstract: A cryogenic catheter includes an outer flexible member having at least one cryogenic fluid path through the flexible member. The at least one fluid path is defined by a plurality of flexible members disposed within the outer flexible member.

Abstract: This invention provides a relatively fast and safe method of producing a permanent or nearly permanent skin image, design, or tattoo similar in appearance to that of a solar tattoo. A protective design template is placed on the skin and a cryogenic agent applied to freeze exposed portions of the skin, producing hypopigmentation. An image is defined by the contrast between the treated (hypopigmented) skin and the adjacent untreated skin.

Abstract: A cryosurgery device for dispensing a liquid refrigerant from a container having a valve stem extending outwardly therefrom. The device includes an actuator adapted to seat on the valve stem of the container in order to depress the valve stem to release the refrigerant from the container. The actuator includes an inner passageway having opposed ends disposed therein, one of the ends of the passageway being in fluid communication with the valve stem. An applicator tube is mounted to the actuator at the other end of the inner passageway. A cap is disposed on the top of the container. The actuator is movably positioned on the cap and a shield is attached to the cap to completely receiving the applicator tube. Liquid refrigerant can only be dispensed when the actuator is positioned properly and the applicator tube is disposed within the shield means.

Abstract: A cryosurgical system and method for supplying cryogen to a probe. The system including a container filled with cryogen and having bellows of a pump submerged within said cryogen. Conduits fluidly interconnect the bellows and a probe that is outside the container to permit the cryogen to be forced from the bellows to the probe upon activation of pump. A pressure relief valve is fluidly coupled to the conduits and positioned between the bellows and the probe. After initially forcing cryogen to the probe at a pressure that establishes a colligative-based sub-cooling of the liquid cryogen, the pressure relief valve is activated to lower the pressure of the cryogen to a running pressure.

Abstract: Method and systems for nerve repair and for microfabrication. In specific embodiments, nerve repair is accomplished by repairing axons. In further embodiments, a modular, 3D system having very small dimentions is described. In further embodiments, a method ans system for performing surgery on axons is disclosed.

Abstract: Home-use applicators for non-invasively removing heat from subcutaneous, lipid-rich cells via phase change coolants, and associated devices, systems and methods. A device in accordance with a particular embodiment includes an applicator releasably positionable in thermal communication with human skin, and a coolant vessel having a coolant. The device further includes a heat transfer conduit operatively coupled to the applicator and housing a heat transfer fluid that is isolated from fluid contact with the coolant. A heat exchanger is operatively coupled between the coolant vessel and the heat transfer conduit to transfer heat between the heat transfer fluid and the coolant, and a fluid driver is operatively coupled to the heat transfer conduit to direct the heat transfer fluid between the applicator and the heat exchanger.

Abstract: A cryogenic medical system includes a medical device and a console connectable to the medical device at a connection point. The console controls the temperature of the medical device. The console includes a first cooling system directing coolant to the medical device at a first temperature along a coolant supply line and a second cooling system chilling the coolant within the coolant supply line to a temperature below the first temperature before the coolant reaches the connection point.

Abstract: A laser treatment device and process with controlled cooling. The device contains a cooling element with high heat conduction properties, which is transparent to the laser beam. A surface of the cooling element is held in contact with the tissue being treated while at least one other surface of the cooling element is cooled by the evaporation of a cryogenic fluid. The cooling is coordinated with the application of the laser beam so as to control the temperatures of all affected layers of tissues. In a preferred embodiment useful for removal of wrinkles and spider veins, the cooling element is a sapphire plate. A cryogenic spray cools the top surface of the plate and the bottom surface of the plate is in contact with the skin. In preferred embodiments the wavelength of the laser beam is chosen so that absorption in targeted tissue is low enough so that substantial absorption occurs throughout the targeted tissue. In a preferred embodiment for treating large spider veins with diameters in the range of 1.