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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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Gökçelli U, Ercan UK, İlhan E, Argon A, Çukur E, Üreyen O. Prevention of Peritoneal Adhesions by Non-Thermal Dielectric Barrier Discharge Plasma Treatment on Mouse Model: A Proof of Concept Study. J INVEST SURG 2019; 33:605-614. [PMID: 30644787 DOI: 10.1080/08941939.2018.1550542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purposes: Formation of peritoneal adhesions is a common consequence of abdominopelvic surgeries and remarkably increases the mortality and morbidity. Moreover, peritoneal adhesions linked to chronic abdominopelvic pain and infertility in women. Various attempts for prevention of peritoneal adhesions were reported. However, these methods either remain insufficient to prevent formation of peritoneal adhesions or carry some practical limitations and thus, there is a need for novel techniques that could effectively decrease the formation of peritoneal adhesions. The aim of the present prospective, randomized, controlled, and single blinded study was to evaluate the effect of non-thermal atmospheric plasma (NTAP) treatment on prevention of peritoneal adhesions. Materials and Methods: Sixteen male CD-1 mice were randomly divided into two groups: control and plasma. Excisional and abrasion adhesion models were generated on the peritoneal side wall and cecum, respectively. Ten days after creating adhesion models, mice were sacrificed and adhesion formations were evaluated macroscopically using Knightly's and Linsky's grading systems to assess the intensity and extent of adhesions, respectively. Zühlke's grading system was used for microscopic assessment of adhesions. Results: The mean scores for peritoneum and cecum in control group according to Knightly's grading system were determined as 3.3 and 2.6, respectively. In NTAP-treated group, Knightly's score was determined as 1.6 and 0.5 for peritoneum and cecum, respectively. NTAP treatment reduced Linsky's score from 3.8 to 1.3 and 2.1 to 1.1 on peritoneum and cecum. Finally, in microscopic evaluation, NTAP treatment reduced Zühlke's score from 3.4 to 1.5 and 2.6 to 1.3 for peritoneum and cecum, respectively. Conclusions: The results of the present proof of concept study suggest that NTAP could be a novel method to reduce and/or prevent the formation of peritoneal adhesions after abdominopelvic surgeries.
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Affiliation(s)
- Uğur Gökçelli
- Department of General Surgery, İzmir Bozyaka Research and Training Hospital, University of Health Sciences, İzmir, Turkey
| | - Utku Kürşat Ercan
- Department of Biomedical Engineering, İzmir Katip Çelebi University, İzmir, Turkey
| | - Enver İlhan
- Department of General Surgery, İzmir Bozyaka Research and Training Hospital, University of Health Sciences, İzmir, Turkey
| | - Asuman Argon
- Department of Pathology, İzmir Bozyaka Research and Training Hospital, University of Health Sciences, İzmir, Turkey
| | - Elif Çukur
- Department of Biomedical Engineering, İzmir Katip Çelebi University, İzmir, Turkey
| | - Orhan Üreyen
- Department of General Surgery, İzmir Bozyaka Research and Training Hospital, University of Health Sciences, İzmir, Turkey
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Kraemer B, Scharpf M, Keckstein S, Dippon J, Tsaousidis C, Brunecker K, Enderle MD, Neugebauer A, Nuessle D, Fend F, Brucker S, Taran FA, Kommoss S, Rothmund R. A prospective randomized experimental study to investigate the peritoneal adhesion formation after waterjet injection and argon plasma coagulation (HybridAPC) in a rat model. Arch Gynecol Obstet 2018; 297:961-967. [PMID: 29362925 DOI: 10.1007/s00404-018-4661-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 01/09/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND This prospective, randomized, controlled, single-blinded study investigates the peritoneal adhesion formation of HybridAPC (waterjet elevation of the peritoneum with subsequent argon plasma coagulation) versus only waterjet (elevation with the same instrument, but without subsequent argon plasma coagulation) in a rat model (24 female Wistar rats). MATERIALS AND METHODS Bilateral lesions were created on the abdominal wall with HybridAPC on one sidewall and waterjet elevation on the other sidewall of the peritoneum in a standard fashion. After 10 days, the rats were euthanized to evaluate the peritoneal trauma sites. MAIN OUTCOME MEASURE(S) Adhesion incidence, quantity, and quality were scored 10 days postoperatively and studied histopathologically. RESULT(S) Incidence of adhesion formation was 2.3% for HybridAPC; no adhesions occurred for peritoneal elevation with saline (p = 1.00). Histologic evaluation revealed no acute inflammation in both groups. An overall moderate degree of granulation tissue formation and myonecrosis was observed in the HybridAPC group, whereas no chronic inflammation and myonecrosis occurred after elevation without thermal ablation (p < 0.0001). CONCLUSION(S) This study investigates the effect of waterjet elevation of the peritoneum with and without subsequent thermal ablation on adhesion formation in a rat model for the first time. Peritoneal waterjet elevation with saline does not provide any risk of adhesion formation. Thermal coagulation with APC after waterjet elevation of the peritoneum creates advantageous peritoneal conditions due to a permanent moist tissue surface and the cooling effect of the injected solution, resulting in no significant difference in adhesion formation compared to peritoneal elevation without thermal ablation. HybridAPC can thus be regarded as a beneficial coagulation method with only minor adhesion formation due to positive tissue effects of the combined waterjet.
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Affiliation(s)
- Bernhard Kraemer
- Department of Obstetrics and Gynecology, University of Tuebingen, Calwerstr. 7, 72076, Tübingen, Germany.
| | - Marcus Scharpf
- Department of Pathology, University of Tuebingen, Liebermeisterstr. 8, 72076, Tübingen, Germany
| | - Simon Keckstein
- Department of Obstetrics and Gynecology, University of Tuebingen, Calwerstr. 7, 72076, Tübingen, Germany
| | - Julia Dippon
- Department of Obstetrics and Gynecology, University of Tuebingen, Calwerstr. 7, 72076, Tübingen, Germany
| | - Christos Tsaousidis
- Department of Obstetrics and Gynecology, University of Tuebingen, Calwerstr. 7, 72076, Tübingen, Germany
| | - Kristin Brunecker
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072, Tübingen, Germany
| | | | | | - Daniela Nuessle
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072, Tübingen, Germany
| | - Falko Fend
- Department of Pathology, University of Tuebingen, Liebermeisterstr. 8, 72076, Tübingen, Germany
| | - Sara Brucker
- Department of Obstetrics and Gynecology, University of Tuebingen, Calwerstr. 7, 72076, Tübingen, Germany
| | - Florin-Andrei Taran
- Department of Obstetrics and Gynecology, University of Tuebingen, Calwerstr. 7, 72076, Tübingen, Germany
| | - Stefan Kommoss
- Department of Obstetrics and Gynecology, University of Tuebingen, Calwerstr. 7, 72076, Tübingen, Germany
| | - Ralf Rothmund
- Department of Obstetrics and Gynecology, University of Tuebingen, Calwerstr. 7, 72076, Tübingen, Germany
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Rothmund R, Scharpf M, Tsaousidis C, Planck C, Enderle MD, Neugebauer A, Kroeker K, Nuessle D, Fend F, Brucker S, Kraemer B. A Prospective Randomized Experimental Study to Investigate the Eradication Rate of Endometriosis after Surgical Resection versus Aerosol Plasma Coagulation in a Rat Model. Int J Med Sci 2016; 13:187-94. [PMID: 26941579 PMCID: PMC4773283 DOI: 10.7150/ijms.14246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 01/22/2016] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To investigate the eradication rate of endometriosis after surgical resection (SR) vs. thermal ablation with aerosol plasma coagulation (AePC) in a rat model. METHODS In this prospective, randomized, controlled, single-blinded animal study endometriosis was induced on the abdominal wall of 34 female Wistar rats. After 14 days endometriosis was either removed by SR or ablated by AePC. 14 days later the rats were euthanized to evaluate the eradication rate histopathologically. Intervention times were recorded. RESULTS Eradication rate of endometriosis after 14 days did not significantly differ between AePC and SR (p=0.22). Intervention time per endometrial lesion was 22.1 s for AePC and 51.8 s for SR (p<0.0001). CONCLUSIONS This study compares the eradication rate of the new aerosol plasma coagulation device versus standard surgical resection of endometriosis in a rat model. Despite being a thermal method, AePC showed equality towards SR regarding eradication rate but with significantly shorter intervention time.
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Affiliation(s)
- Ralf Rothmund
- 1. Department of Obstetrics and Gynaecology, University of Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany (Director: Prof. D. Wallwiener)
| | - Marcus Scharpf
- 2. Department of Pathology, University of Tuebingen, Liebermeisterstr. 8, 72076 Tuebingen, Germany (Director: Prof. F. Fend)
| | - Christos Tsaousidis
- 1. Department of Obstetrics and Gynaecology, University of Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany (Director: Prof. D. Wallwiener)
| | - Constanze Planck
- 1. Department of Obstetrics and Gynaecology, University of Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany (Director: Prof. D. Wallwiener)
| | | | | | - Kristin Kroeker
- 3. Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072 Tuebingen, Germany
| | - Daniela Nuessle
- 3. Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072 Tuebingen, Germany
| | - Falko Fend
- 2. Department of Pathology, University of Tuebingen, Liebermeisterstr. 8, 72076 Tuebingen, Germany (Director: Prof. F. Fend)
| | - Sara Brucker
- 1. Department of Obstetrics and Gynaecology, University of Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany (Director: Prof. D. Wallwiener)
| | - Bernhard Kraemer
- 1. Department of Obstetrics and Gynaecology, University of Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany (Director: Prof. D. Wallwiener)
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Beyene RT, Kavalukas SL, Barbul A. Intra-abdominal adhesions: Anatomy, physiology, pathophysiology, and treatment. Curr Probl Surg 2015; 52:271-319. [PMID: 26258583 DOI: 10.1067/j.cpsurg.2015.05.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 05/12/2015] [Indexed: 12/18/2022]
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Randomized experimental study to investigate the peritoneal adhesion formation of conventional monopolar contact coagulation versus noncontact argon plasma coagulation in a rat model. Fertil Steril 2014; 102:1197-202. [DOI: 10.1016/j.fertnstert.2014.07.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 06/14/2014] [Accepted: 07/02/2014] [Indexed: 11/19/2022]
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Kraemer B, Rothmund R, Fischer K, Scharpf M, Smaxwil L, Enderle MD, Wallwiener C, Neugebauer A. A Prospective Experimental Study to Investigate the Peritoneal Adhesion Formation of Argon Plasma Coagulation (APC) Versus a Novel Aerosol Plasma in a Rat Model. Surg Innov 2013; 21:389-97. [DOI: 10.1177/1553350613506300] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. This is a prospective, randomized, controlled, single-blinded study to investigate peritoneal adhesion formation of standard argon plasma coagulation (APC) versus aerosol plasma coagulation in a rat model. Methods. Bilateral lesions were created on the abdominal wall of 16 female Wistar rats with standard and aerosol plasma coagulation APC energy in a standard fashion. After 10 days, the rats were killed humanely to evaluate the peritoneal trauma sites. Adhesion incidence, quantity, and quality were scored 10 days postoperatively and studied histopathologically. Results. Average energy intake was 97.7 ± 3.1 J for APC and 93.8 ± 4.2 J for aerosol plasma coagulation. Incidence of adhesion formation was 74.2% for standard APC and 16.1% for aerosol plasma coagulation ( P < .0001). Standard APC mainly results in dense adhesions. Histological evaluation revealed no significant difference with regard to the average depth of lesions created by APC and aerosol plasma coagulation ( P = 0.21) at day 10; both groups showed an identical morphology of necrosis and granulation tissue formation. Conclusions. This study compares adhesion formation of standard APC versus aerosol plasma coagulation in a rat model. Standard APC produced significantly more adhesions. Aerosol plasma coagulation creates fewer adhesions, which are of lower grade, which seems to be achieved mainly by improved peritoneal conditioning in this animal model.
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Vettoretto N, Carrara A, Corradi A, De Vivo G, Lazzaro L, Ricciardelli L, Agresta F, Amodio C, Bergamini C, Borzellino G, Catani M, Cavaliere D, Cirocchi R, Gemini S, Mirabella A, Palasciano N, Piazza D, Piccoli M, Rigamonti M, Scatizzi M, Tamborrino E, Zago M. Laparoscopic adhesiolysis: consensus conference guidelines. Colorectal Dis 2012; 14:e208-15. [PMID: 22309304 DOI: 10.1111/j.1463-1318.2012.02968.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Laparoscopic adhesiolysis has been demonstrated to be technically feasible in small bowel obstruction and carries advantages in terms of post-surgical course. The increasing dissemination of laparoscopic surgery in the emergency setting and the lack of concrete evidence in the literature have called for a consensus conference to draw recommendations for clinical practice. METHODS A literature search was used to outline the evidence, and a consensus conference was held between experts in the field. A survey of international experts added expertise to the debate. A public jury of surgeons discussed and validated the statements, and the entire process was reviewed by three external experts. RESULTS Recommendations concern the diagnostic evaluation, the timing of the operation, the selection of patients, the induction of the pneumoperitoneum, the removal of the cause of obstructions, the criteria for conversion, the use of adhesion-preventing agents, the need for high-technology dissection instruments and behaviour in the case of misdiagnosed hernia or the need for bowel resection. CONCLUSION Evidence of this kind of surgery is scanty because of the absence of randomized controlled trials. Nevertheless laparoscopic skills in emergency are widespread. The recommendations given with the consensus process might be a useful tool in the hands of surgeons.
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Affiliation(s)
- N Vettoretto
- Laparoscopic Surgery Unit, M. Mellini Hospital, Chiari, Italy.
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