Introduction/Background Advanced hemostasis devices – primarily electrothermal bipolar vessel sealing devices and ultrasonic devices – are frequently used in vulvar cancer surgery but their effect on the perioperative outcomes of vulvar surgery is unknown. We aimed to compare the incidence and severity of immediate postoperative complications, as well as operative time and blood loss, of vulvar cancer surgery between patients operated with advanced hemostasis devices and traditional electrocautery.

Methodology We retrospectively reviewed the electronic operative records of all patients having undergone surgery for primary vulvar squamous cell cancer in Tampere University Hospital between 2005 – 2021. Patients with non-squamous cell cancers, history of previous vulvar surgery, neoadjuvant chemotherapy or surgeries with palliative intent were excluded from this study. A total of 123 patients were included (advanced hemostasis devices n=73, traditional electrocautery n=50).

Operative time and estimated blood loss were compared using Mann-Whitney U test. A Clavien-Dindo grade was defined for the immediate 30-day postoperative period of each patient and grades 0-I were considered an uncomplicated recovery. Clavien-Dindo grades were compared using Fisher’s exact test.

Results Clavien-Dindo grades 0-I were more frequent in the advanced hemostasis device group (26.0% vs 10.0%, p=0.036). Median blood loss was 150ml (interquartile range 300ml) vs 400ml (IQR 750ml; p<0.001) in the advanced hemostasis and traditional electrocautery groups, respectively. Median operative time was 157min (IQR 106min) vs 149 min (IQR 58min; p=0.398) in the advanced hemostasis and traditional electrocautery groups, respectively. Uni- or bilateral inguinofemoral lymphadenectomies were performed in 56.2% vs. 78.0% and sentinel node biopsies in 35.6% vs. 16.0% of the surgeries in the advanced hemostasis and traditional electrocautery groups, respectively.

Conclusion A significant reduction in postoperative complications (Clavien-Dindo 2+) and operative blood loss has occurred in our center since the introduction of advanced hemostasis devices in vulvar cancer surgery. No significant advantage in operative time was found.

Disclosures All authors declare that they have no conflicts of interest.