Use of Laparoscopic and Laparotomic J-Plasma Handpiece in Gynecological Malignancies: Results From A Pilot Study in A Tertiary Care Center

Abstract

IntroductionThe J-Plasma has recently been introduced into the surgical community with different intrinsic characteristics aimed to further reduce the thermal effect and enhance precision when compared to standard radiofrequency. This study aimed to investigate the role of this new technology in different conditions of gynecological carcinomatosis characterized by the indication for regional peritonectomy and/or ablation, either in laparotomy (LPT) or in laparoscopy (LPS), in the context of a modern personalized approach to the surgical management of gynecological malignancies.Material and MethodsFrom January 2019 to April 2019, 12 patients were selected for this prospective pilot study at the Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS in Rome. In this single surgeon experience, the inclusion criteria were: histologically proven advanced ovarian/endometrial cancer, primary or interval debulking surgery, and intraoperative indication for regional peritonectomy. Six patients were treated by LPS (Group 1) and 6 by LPT (Group 2).ResultsIn Group 1 the indication for debulking surgery was in 4 cases an interval debulking surgery and 2 advanced endometrial cancer. All patients in Group 2 underwent primary debulking surgery for advanced ovarian cancer. The whole cohort achieved a complete tumor excision after surgery. The median OT and median EBL were 195 min and 100 ml in Group 1, and 420 min and 500 ml in Group 2. The median hospital stay was 4 days in Group 1 and 13 days in Group 2, respectively. No intra and postoperative complications were registered within 60 days after surgery.ConclusionsJ-Plasma allows to approach delicate maneuvers on viscera, mesentery, and blood vessels with a high degree of safety and precision thanks to its limited vertical and lateral thermal spread, favoring the surgeon to push ever higher the cytoreduction/morbidity tradeoff. The use of J-Plasma in cytoreductive surgery could also increase the range of possible minimally invasive procedures, narrowing the technical distance with the open technique and thus contributing to designing a personalized surgical strategy for each patient in different scenarios of peritoneal carcinomatosis.

Experience With J-Plasma Device in Achieving Complete Cytoreduction in Patients With Ovarian Cancer

“…According to their results, J-Plasma was applicable when the surgeons were facing disease on the bowel serosa without infiltration of the intestinal wall, on the diaphragmatic peritoneum and on the intestinal mesentery. Furthermore, in Gueli Alletti et al concluded that surgeons reached the learning curve after three procedures; a statement that was confirmed by our initial experience with J-Plasma device (18). The use of cold atmospheric helium plasma has been recently introduced into the surgical treatment for several different pathologies from several different specialties.…”

“…In the past, in order to achieve complete cytoreduction in such patients a bowel resection was inevitable. The use of plasma energy facilitates the removal of disease in the bowel serosa (rectal shaving) (18). With the use of J-Plasma such lesions on the bowel's mesentery could be removed without damaging the blood supply and without the need of bowel resection and anastomoses, procedures that add surgical time and possible intra-and postoperative complications such as leakage (Figure 5).…”

Plasma Device Functions and Tissue Effects in the Female Pelvis—A Systematic Review

“…The injury was smaller than that created with monopolar and bipolar ES devices. Furthermore, it was observed that the J-Plasma device (40% power, 4.0 l/min gas flow, 80 pulse setting) enabled the collection of peritoneal biopsies with cleaner edges compared to monopolar ES [ 18 ].…”

Ultrasound-guided robotic surgical procedures: a systematic review

“…In the last few decades, there has been a rapid succession of technological advances, marking a radical shift from the open to the minimally invasive surgical (MIS) approach [ 1 ]. The advantages of laparoscopy over laparotomy are now widely acknowledged [ 2 ].…”