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EP1177 New surgical approaches in management of pre-invasive diseases of vulva. Preliminary experience with Plasmajet surgery in management of vulvar intraepithelial neoplasma and Morbus Paget
  1. M Michal,
  2. P Valha and
  3. M Veleminsky
  1. Obstetrics and Gynaecology Department, Ceske Budejovice Hospital, Ceske Budejovice, Czech Republic


Introduction/Background The Plasmajet surgery system (Plasma surgical, Atlanta, GA, USA) was developed for atraumatic surgery using kinetic disection, microlayer vaporisation and surface sealing. Allows enhanced visualization, opening, and dissection of tissue planes. Thermal effect is limited, less than 0.3 mm depth and 0,5 mm lateral. That allows to perform safe surgery close to key structures such as bowel, veins or nerves. Exept abdominal surgery, Plasmajet can be also used in lower genital region in management of pre-invasie diseases of vulva.

Methodology Pacients were selected by results of histology and expertise colposcopical examination. Plasmajet skinning hemi/vulvectomy were performed at pacients with multifocal HG vulvar intraepithelial neoplasia. Pacients with multifocal Morbus Paget of vulva were treated by deeper excizion including dermis. Moist wound healing was performed using Nu-Gel (SWML, Gargrave NY, U.K.) and Mepilex Border (Molnlycke Healt Care AB, Goteborg, SE).

Results So far we had 5 pacients with multifocal HG vulvar intraepithelial neoplasia treated by Plasmajet skinning vulvectomy. In all cases final histology was without invasion. Clear margins were obtained in four cases. Healing was without infalmatory complications in all cases, median healing time was 8 weeks. Two pacients with multifocal Morbus Paget of vulva were treated by deeper Plasmajet excision, clear margins were obtained and final histology was without invasion. Healing was without inflamatory complications, median healing time was 11,5 weeks.

Conclusion The Plasmajet surgery is suitable technique for management of pre-invasive diseases of vulva allowing precise dissection of tissue. In larger leasions, where size of defect doesnt allow performing suture, can decrease time of healing due to more gentle surgery performed. In management of Morbus Paget of vulva, where laser surgery doesnt allow required radicality, Plasmajet can be optimal technique allowing precise atraumatic surgery with required radicality.

Disclosure Nothing to disclose

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