ABSTRACT
Ablative Techniques Extensive small-volume ovarian cancer spread over the bowel mesenteric surface can also be effectively eradicated using ablative techniques. Bristow and Montz (33) reported their experience using the argon beam coagulator in cytoreductive surgery for patients with advanced-stage ovarian cancer. Power settings of 60 to 80 W were typically used to ablate subcentimeter implants and tumor nodules. Higher settings of 100 to 110 W were used for larger nodules or tumor plaques. The use of the argon beam coagulator was associated with a greater likelihood of achieving complete cytoreduction, with no gross residual disease, compared to patients debulked by more traditional methods. When examining its use on the bowel mesentery, specifically, 80% of patients were able to have their mesenteric disease completely removed compared with 0% when the argon beam coagulator was not used. Tumor ablation of intestinal metastasis using a CO2 laser has also been described by Fanning et al. (34). Twenty consecutive patients with epithelial ovarian cancer and metastasis to the mesentery and/or serosa of the small and/or large bowel were cytoreduced with the CO2 laser. In 19 of the 20 patients, all tumor was removed from intestine using laser ablation. This method of intensive cytoreduction resulted in superior debulking without increasing postoperative morbidity. A newer form of ablative technique employs plasma energy. This form of coagulation does not require conduction of an electrical current through the patient. Instead, a low-voltage electrical current (30 V) is used to ionize argon gas to form plasma. High temperatures are then created within the plasma, but at a low mass flow rate. The argon plasma transfers this heat (kinetic) energy to coagulate tissue for rapid and complete hemostasis. The surface temperature of the affected coagulated tissue is approximately 1008C. This high temperature causes the liquid component of the tissue to vaporize. In an ex vivo model, plasma energy has been used for effective tissue destruction while minimizing lateral thermal damage (35). Irrespective of the type of energy source employed, the operating surgeon should be aware of the potential for underlying thermal damage, especially when operating on visceral and vascular structures.
