Advances in cryosurgery since 1990 were initiated by the development of improved cryosurgical equipment and by the availability of intraoperative ultrasound to monitor the tissue-freezing process. Interest in research on the effects of freezing on tissue and on new clinical applications was then stimulated. The research led to a better understanding of the mechanisms of cryogenic injury, including cell death by apoptosis, which has emerged as a potential key to the use of adjunctive chemotherapy in the treatment of cancer. Optimization of cryosurgical technique will also improve clinical results.