Is there an increased risk for tumor dissemination using ultrasonic surgical aspiration in patients with vulvar carcinoma?
The ultrasonic surgical aspirator (USA) is a new surgical instrument that allows precise and selective tissue dissection. Ultrasonic cell destruction is combined with continuous irrigation causing a cloud of fine droplets, which sometimes contains viable tumor cells, hanging above the operative field. We present a patient who developed massive recurrent vulvar carcinoma in the subcutaneous tissue in the proximity of the incisions of the vulva and both groins 3.5 months after a USA-assisted radical vulvectomy and inguinal lymphadenectomy. The atypical pattern of recurrence in the entire operative field suggests that tumor cells might have been spread by the irrigation fluid of the USA. Further investigation is needed to assess the risk of tumor dissemination with USA before the instrument can be used safely in patients with early cancer.
Department of Obstetrics and Gynaecology, Antwerp University Hospital, Edegem, Belgium.
P A
PA
van Dam
M
M
Coppens
A T
AT
van Oosterom
E
E
Van Marck
P
P
Buytaert
D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology*; D012307:Risk Factors; D013396:Suction / Q000009:adverse effects* / Q000379:methods; D014463:Ultrasonography; D014846:Vulvar Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*