Hybrid argon plasma coagulation (HybridAPC) versus sharp excision for the treatment of endometriosis: a prospective randomized clinical trial

• Published in: Archives of Gynecology and Obstetrics Vol. 307; no. 1; pp. 187 - 194
• Main Authors: Keckstein, Julia S., Keckstein, Simon, Brunecker, Kristin, Neugebauer, Alexander, Nüssle, Daniela, Hoffmann, Sascha, Andress, Jürgen, Neis, Felix, Scharpf, Marcus, Enderle, Markus, Rothmund, Ralf, Brucker, Sara Y., Jun, Martin Weiss, Kraemer, Bernhard
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Science and Business Media LLC 01.01.2023; Springer Berlin Heidelberg; Springer Nature B.V
• Subjects: Argon Plasma Coagulation; Clinical trials; Endocrinology; Endometriosis; Endometriosis - pathology; Endometriosis - surgery; Female; General Gynecology; Gynecology; Human Genetics; Humans; Laparoscopy; Laparoscopy - methods; Medicine; Medicine & Public Health; Obstetrics/Perinatology/Midwifery; Peritoneum; Peritoneum - pathology; Prospective Studies; Tissue Adhesions; Tissue Adhesions - pathology; Tissue Adhesions - prevention & control; Tissue Adhesions - surgery; Peritoneal adhesion formation; Non-contact thermal ablation; Peritoneal endometriosis; Waterjet
• ISSN: 1432-0711; 0932-0067; 1432-0711
• DOI: 10.1007/s00404-022-06473-9

Purpose Endometriosis is a benign, but potentially serious gynaecological condition in terms of abdominal pain and impaired fertility. Laparoscopic excision techniques are considered the therapeutic standard. HybridAPC is presented as a novel technique for the non-contact thermal ablation of peritoneal endometriosis with simultaneous protection of the underlying thermosensitive structures by creating a needle-free elevated fluid cushion which enables a safer exposure and distance, as well as potentially improved peritoneal conditioning prior to APC. Methods In this prospective randomized clinical trial, 39 patients with 132 superficial endometriotic lesions in total were treated with HybridAPC or sharp excision in an initial laparoscopic procedure according to randomization. In a second-look laparoscopy, adhesion formation was rated macroscopically. Histologic samples were taken from previously treated areas for evaluation of eradication rate. Results The eradication rate was not significantly different between HybridAPC treatment and sharp excision (65 vs. 81%, p  = .55). Adhesions formed in 5% of HybridAPC-treated lesions and in 10% after sharp excision ( p  = .49). HybridAPC treatment was significantly faster than sharp excision (69 vs. 106 s, p  < .05). No intra- and postoperative complications were registered. Conclusion This clinical trial demonstrates the feasibility of this novel surgical technique with a promising impact on adhesion prevention. Compared to sharp excision, HybridAPC is likely to be a safe, tissue-preserving, and fast method for the treatment of peritoneal endometriosis.