Electrosurgical devices in gynecologic oncology: a systematic review of clinical studies

Electrosurgical instruments are a crucial component in the surgical treatment of gynecologic malignancies, enabling precise dissection and effective hemostasis, influencing blood loss, operative time and complication rates. Considering their importance in oncological outcomes and increasing variety, comparative data in the literature remains limited. Our aim is to comprehensively assess and compare clinical outcomes across electrosurgical modalities in gynecologic cancer surgery.

Following PRISMA guidelines, we performed a systematic search of three electronic databases (PubMed, Cochrane Library, Scopus). Eligible studies since 2005 enrolled women (≥18 years) undergoing surgery for gynecological neoplasms, in which electrosurgical devices were used. Clinically relevant outcomes, such as intraoperative blood loss, operative time, perioperative complication rates, surgeon's experience and length of hospital stay were compared.

359 publications were reviewed after literature search, 10 of them fitted the inclusion criteria, 1 additional publication was added after references review. Most of the studies (36.4%) evaluated cervical cancer only, followed by studies that included both cervical and endometrial cancer (27.3%), while 18.2% of the studies focused on endometrial and ovarian cancer each. Majority of the articles (82%) evaluated advanced electrosurgical devices alone or in comparison with standard electrosurgery or conventional methods. LigaSure was the most commonly used advanced electrosurgical device, followed by THUNDERBEAT, PlasmaJet™, PlasmaKinetic tissue management system and ERBE BiClamp® forceps. All of the studies assessed more than one perioperative outcome, with the most common being estimated blood loss, operative time and duration of hospitalization.

Despite heterogeneous design and outcomes, most findings suggest that advanced electrosurgical devices are associated with mostly better perioperative outcomes in oncological patients undergoing surgery. It can be concluded that the effectiveness of the device and the appropriate instrument selection differs between malignancies, depending on the cancer type and operative procedure performed. Given the diversity of the studies we believe that additional well-designed studies using standardized outcomes sets are needed.