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Treatment of vulvar and vaginal dysplasia: plasma energy ablation versus carbon dioxide laser ablation
  1. Anna Beavis1,
  2. Omar Najjar1,
  3. Tricia Murdock2,
  4. Ashley Abing3,
  5. Amanda Fader1,
  6. Stephanie Wethington1,
  7. Rebecca Stone1,
  8. James Stuart Ferriss1,
  9. Edward J Tanner4 and
  10. Kimberly Levinson1
  1. 1Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  2. 2Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  3. 3Department of Biology, Johns Hopkins University, Baltimore, Maryland, USA
  4. 4Department of Obstetrics and Gynecology, Northwestern Medicine, Chicago, Illinois, USA
  1. Correspondence to Dr Anna Beavis, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; abeavis2{at}


Objective Plasma energy ablation vaporizes tissues similar to carbon dioxide laser ablation, but is not hindered by the unique hazards and regulation of laser technology. We aimed to evaluate the complication rate and effectiveness of plasma versus laser ablation in the treatment of vulvovaginal high-grade squamous intra-epithelial lesions (HSIL).

Methods We performed a retrospective cohort study of women treated with plasma or carbon dioxide laser ablation for histologically proven HSIL of the vulva or vagina from January 2014 to October 2019 at a single institution. Demographic factors, surgical characteristics, and complications were compared by ablation type using Fisher’s exact tests. Recurrence-free survival was evaluated by ablation type using Kaplan–Meier curves, weighted log-rank tests, and Cox proportional hazards ratio estimates.

Results Forty-two women were included; 50% underwent plasma and 50% underwent carbon dioxide laser ablation. Demographic factors were similar between the groups. 50% (n=21) were immunosuppressed, 45.2% (n=19) had prior vulvovaginal HSIL treatment, and 35.7% (n=15) were current smokers. Most women (n=25, 59.5%) were treated for vulvar HSIL, 38.1% (n=16) for vaginal HSIL. Complication rates did not differ by treatment: 9.5% (n=2) for laser ablation versus 4.8% (n=1) for plasma ablation (p=1.0). Over a median follow-up time of 29.3 months (IQR 11.0–45.0 months), recurrence rates were similar: 28.6% in the laser ablation group versus 33.3% in the plasma ablation group (weighted log rank p=0.43; 24-month HR 0.54, 95% CI 0.15 to 2.01).

Conclusion Plasma energy ablation of vulvovaginal HSIL has similar complication rates and recurrence risk to carbon dioxide laser ablation. This technique could be considered as an alternative treatment modality for vulvovaginal HSIL and warrants further investigation.

  • vulvar and vaginal cancer
  • vulvar diseases
  • vulvar neoplasms
  • genital neoplasms
  • female
  • gynecologic surgical procedures

Data availability statement

Data are available upon reasonable request.

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  • Contributors AB and KL were responsible for the conception and data analysis. They were also responsible for data interpretation, along with TM, AF, SW, RS, JSF, and EJT. TM, ON and AA participated in data collection and management. AB, ON and KL drafted the initial manuscript. All authors reviewed and critically revised the manuscript, and all authors approved the manuscript in its final version prior to submission for publication.

  • Funding The statistical analysis was supported by the Johns Hopkins Institute for Clinical and Translational Research (ICTR) which is funded in part by Grant Number UL1 TR003098 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official view of the Johns Hopkins ICTR, NCATS or NIH.

  • Competing interests RS reports personal consulting fees from Astra Zeneca and is on an advisory board for GlaxoSmithKline, unrelated to the present work.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.