Complete Cytoreduction of Advanced Ovarian
Malignancy using Neutral Argon Plasma
Madhuri TK , Tailor A , Butler-Manuel SA
Department of Gynaecological Oncology
Royal Surrey County Hospital, Guildford, UK
Ovarian cancer is 2nd common gynaecological cancer after breast and is
the commonest cause of death. Management includes surgery and
chemotherapy with a good initial response but women often relapse.1
Data has consistently shown that complete cytoreductive surgery improves
survival. 2 (figure 1 & 2)
There has been no new technology since 2001 when the Argon Beam
coagulator (ABC) was used to produce complete cytoreduction. The
PlasmaJet™ (PJ) is a new surgical device releasing neutral argon plasma.
Prospective, observational study performed with satisfactory results. 3
Figure 2 PJ being used to ablate
tumour nodules on bowel surfaces.
Figure 3 PJ coagulating bleeding
areas on bowel surfaces.
15 primary debulking procedures for advanced ovarian cancer
6 secondary debulking procedures for recurrent ovarian cancer
Pooled data from Chu et al confirms that optimal surgery is associated with
increased survival. (Table 1)
Traditionally the benchmark for optimal surgery has been <1cm
Today, the aim of complete cytoreduction is to leave no macroscopic
Evaluate the feasibility and outcome of conversion from optimal
cytoreduction (</=1cm) to microscopic disease only in open and
Survival of Patients in months With Advanced Ovarian Cancer According to
the Amount of Residual Tumor after Primary Cytoreduction
6 on day 2
Residual disease: complete cytoreduction achieved in 17 cases.
No intra op/post op complications
Safe to use as compared with other devices
Easy to use
Plasma: a collection of high energy small particles including free atoms, ions
and electrons produced by heating a gas. PJ is a new device for clinical use
designed to produce a fine jet of Argon plasma by heating argon gas.
Widely applicable to a wide variety of open and laparoscopic gynae surgery
Materials & Methods
Prospective study in tertiary oncology centre. PJ used in 15
laparotomies and 6 laparoscopic debulking.
Patient demographics, intra and post-operative data collected.
Size/location of pre-surgical disease, procedures performed,
tissue and anatomical location subjected to PJ, power settings
and time taken to ablate tumour deposits recorded.
PJ used to treat peritoneal deposits of EOC metastases on serosal surface
of small and large bowel in all 11/15 open cases and treat deposits on the
serosal surface of the liver, diaphragm and peritoneal undersurface of the
pericardium with no adverse affects in the 6 laparoscopic cases. 4/6
presented with recurrent disease >19 months following treatment. Disease
on liver surface and diaphragmatic nodules resected with no visible disease.
Innovative surgical device to achieve optimal cytoreduction by ablation and
destruction of tumour implants on visceral surfaces without the risk of lateral
thermal spread in open or laparoscopic debulking surgery
Prospective, multicentre RCTs required to establish place in Gynaecological
Correspondence to: [email protected]
Heintz AP, Odicino F, Maisonneuve P et al. Carcinoma of the ovary. FIGO 6th Annual Report on the Results of
Treatment in Gynecological Cancer. Int J Gynaecol Obstet 2006; 95 (Suppl 1): S161–92.
Madhuri TK, Papatheodorou D, Tailor A, Sutton CJ, Butler-Manuel SA. First clinical experience of argon neutral
plasma energy in gynaecological surgery in the UK. Gynecol Surg. DOI 10.1007/s10397-010-0591-2
Sonoda Y, Overa N, Chi DS, Brown, CL et al. Pathologic Analysis of Ex-vivo Plasma Energy Tumor
Destruction in Patients with Ovarian or Peritoneal Cancer. Proceedings from SGO Annual Congress 2009.