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van de Berg NJ, Nieuwenhuyzen-de Boer GM, Gao XS, Rijstenberg LL, van Beekhuizen HJ. Plasma Device Functions and Tissue Effects in the Female Pelvis-A Systematic Review. Cancers (Basel) 2023; 15:cancers15082386. [PMID: 37190314 DOI: 10.3390/cancers15082386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/07/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
Medical use of (non-)thermal plasmas is an emerging field in gynaecology. However, data on plasma energy dispersion remain limited. This systematic review presents an overview of plasma devices, fields of effective application, and impact of use factors and device settings on tissues in the female pelvis, including the uterus, ovaries, cervix, vagina, vulva, colon, omentum, mesenterium, and peritoneum. A search of the literature was performed on 4 January 2023 in the Medline Ovid, Embase, Cochrane, Web of Science, and Google Scholar databases. Devices were classified as plasma-assisted electrosurgery (ES) using electrothermal energy, neutral argon plasma (NAP) using kinetic particle energy, or cold atmospheric plasma (CAP) using non-thermal biochemical reactions. In total, 8958 articles were identified, of which 310 were scanned, and 14 were included due to containing quantitative data on depths or volumes of tissues reached. Plasma-assisted ES devices produce a thermal effects depth of <2.4 mm. In turn, NAP effects remained superficial, <1.0 mm. So far, the depth and uniformity of CAP effects are insufficiently understood. These data are crucial to achieve complete treatment, reduce recurrence, and limit damage to healthy tissues (e.g., prevent perforations or preserve parenchyma). Upcoming and potentially high-gain applications are discussed, and deficits in current evidence are identified.
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Affiliation(s)
- Nick J van de Berg
- Department of Gynaecological Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, 2628 CD Delft, The Netherlands
| | - Gatske M Nieuwenhuyzen-de Boer
- Department of Gynaecological Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Albert Schweitzer Hospital, 3318 AT Dordrecht, The Netherlands
| | - Xu Shan Gao
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - L Lucia Rijstenberg
- Department of Pathology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Heleen J van Beekhuizen
- Department of Gynaecological Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
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Keckstein JS, Keckstein S, Brunecker K, Neugebauer A, Nüssle D, Hoffmann S, Andress J, Neis F, Scharpf M, Enderle M, Rothmund R, Brucker SY, Jun MW, Kraemer B. Hybrid argon plasma coagulation (HybridAPC) versus sharp excision for the treatment of endometriosis: a prospective randomized clinical trial. Arch Gynecol Obstet 2023; 307:187-194. [PMID: 35284956 PMCID: PMC9837017 DOI: 10.1007/s00404-022-06473-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/16/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Endometriosis is a benign, but potentially serious gynaecological condition in terms of abdominal pain and impaired fertility. Laparoscopic excision techniques are considered the therapeutic standard. HybridAPC is presented as a novel technique for the non-contact thermal ablation of peritoneal endometriosis with simultaneous protection of the underlying thermosensitive structures by creating a needle-free elevated fluid cushion which enables a safer exposure and distance, as well as potentially improved peritoneal conditioning prior to APC. METHODS In this prospective randomized clinical trial, 39 patients with 132 superficial endometriotic lesions in total were treated with HybridAPC or sharp excision in an initial laparoscopic procedure according to randomization. In a second-look laparoscopy, adhesion formation was rated macroscopically. Histologic samples were taken from previously treated areas for evaluation of eradication rate. RESULTS The eradication rate was not significantly different between HybridAPC treatment and sharp excision (65 vs. 81%, p = .55). Adhesions formed in 5% of HybridAPC-treated lesions and in 10% after sharp excision (p = .49). HybridAPC treatment was significantly faster than sharp excision (69 vs. 106 s, p < .05). No intra- and postoperative complications were registered. CONCLUSION This clinical trial demonstrates the feasibility of this novel surgical technique with a promising impact on adhesion prevention. Compared to sharp excision, HybridAPC is likely to be a safe, tissue-preserving, and fast method for the treatment of peritoneal endometriosis.
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Affiliation(s)
- Julia S. Keckstein
- Department of Women’s Health, Tuebingen University Hospital, Calwerstr. 7, 72076 Tübingen, Germany ,Department of Obstetrics and Gynecology, Klinikum Starnberg, Oßwaldstr. 1, 82319 Starnberg, Germany
| | - Simon Keckstein
- Department of Women’s Health, Tuebingen University Hospital, Calwerstr. 7, 72076 Tübingen, Germany ,Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Kristin Brunecker
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072 Tübingen, Germany
| | | | - Daniela Nüssle
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072 Tübingen, Germany
| | - Sascha Hoffmann
- Department of Women’s Health, Tuebingen University Hospital, Calwerstr. 7, 72076 Tübingen, Germany
| | - Jürgen Andress
- Department of Women’s Health, Tuebingen University Hospital, Calwerstr. 7, 72076 Tübingen, Germany
| | - Felix Neis
- Department of Women’s Health, Tuebingen University Hospital, Calwerstr. 7, 72076 Tübingen, Germany
| | - Marcus Scharpf
- Department of Women’s Health, Tuebingen University Hospital, Calwerstr. 7, 72076 Tübingen, Germany
| | - Markus Enderle
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072 Tübingen, Germany
| | - Ralf Rothmund
- Department of Women’s Health, Tuebingen University Hospital, Calwerstr. 7, 72076 Tübingen, Germany ,Praxis Im Frauenzentrum Lindenhofspital, 3012 Bern, Switzerland
| | - Sara Y. Brucker
- Department of Women’s Health, Tuebingen University Hospital, Calwerstr. 7, 72076 Tübingen, Germany
| | - Martin Weiss Jun
- Department of Women’s Health, Tuebingen University Hospital, Calwerstr. 7, 72076 Tübingen, Germany
| | - Bernhard Kraemer
- Department of Women’s Health, Tuebingen University Hospital, Calwerstr. 7, 72076 Tübingen, Germany
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Foster JM, Alexander HR, Zhang C. Regional therapy trials in peritoneal metastases: The path to standardization-Colorectal cancer. J Surg Oncol 2021; 125:57-63. [PMID: 34897714 DOI: 10.1002/jso.26740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Jason M Foster
- Division of Surgical Oncology, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - H Richard Alexander
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Chunmeng Zhang
- Division of Surgical Oncology, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Adhesion prevention after endometriosis surgery - results of a randomized, controlled clinical trial with second-look laparoscopy. Langenbecks Arch Surg 2021; 406:2133-2143. [PMID: 34036409 PMCID: PMC8481146 DOI: 10.1007/s00423-021-02193-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/10/2021] [Indexed: 12/02/2022]
Abstract
Purpose Adhesion formation after endometriosis surgery is a severe problem affecting up to 90% of patients. Possible complications include chronic pain, ileus, and secondary infertility. Therefore, effective adhesion prophylaxis is desirable, for which the adhesion barrier 4DryField® PH is evaluated in the present clinical study. It is a starch-based powder that forms a gel after irrigation with saline solution and thus separates surgical sites as physical barrier for adhesion prevention. Methods Fifty patients with extensive and deep infiltrating endometriosis were included in this prospective, randomized, controlled clinical trial with two-staged laparoscopic approach. The patients were randomized into two groups, one receiving 4DryField® PH and the other irrigation with saline solution for adhesion prevention. Adhesion formation was directly scored during second-look interventions considering incidence, extent, and severity. Adhesion prevention treatment in the second surgery was performed corresponding to the first intervention to evaluate the long-term outcome in the later course. Results Both groups were comparable with respect to relevant patient parameters. Severity and extent of adhesions were significantly reduced by 85% in the 4DryField® PH group compared to the control group (mean total adhesion score 2.2 vs. 14.2; p = 0.004). Incidence of adhesion formation based on the number of affected sites was significantly reduced by 53% in the intervention vs. control group (mean 1.1 vs. 2.3 sites; p = 0.004). Follow-up of secondary endpoints is not yet completed; results will become available at a later stage. Conclusion Adhesion formation could be reduced significantly by 85% by application of the adhesion barrier 4DryField® PH. Trial registration Trial registration main ID: DRKS00014720, secondary ID: U1111-1213-4142; date of registration 09th May 2018.
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