Plasma Device Functions and Tissue Effects in the Female Pelvis-A Systematic Review

Simple Summary Plasmas are used in various forms and with various functions in gynaecology. Knowledge on plasma-tissue effects and target coverage is crucial to achieve complete treatment, reduce recurrence, and limit damage to healthy tissues. In this review, historical and future plasma applications are summarized, and the depths of (non-)thermal effects are evaluated in tissues of the female pelvis. A literature search was performed in the Medline Ovid, Embase, Cochrane, Web of Science, and Google Scholar databases. Fourteen articles were found with data on thermal effects depth. For plasma-assisted electrosurgical devices, depths (<2.4 mm) relied on current dispersion in tissue. In turn, for electrically neutral argon plasma, depths remained superficial (<1.0 mm). The depth and uniformity of cold atmospheric plasma effects requires further investigation. This review identifies upcoming and potentially high-gain applications of plasma in the field of gynaecology, of which the therapeutic effectiveness must be examined in translational and clinical studies. Medical use of (non-)thermal plasmas is an emerging field in gynaecology. However, data on plasma energy dispersion remain limited. This systematic review presents an overview of plasma devices, fields of effective application, and impact of use factors and device settings on tissues in the female pelvis, including the uterus, ovaries, cervix, vagina, vulva, colon, omentum, mesenterium, and peritoneum. A search of the literature was performed on 4 January 2023 in the Medline Ovid, Embase, Cochrane, Web of Science, and Google Scholar databases. Devices were classified as plasma-assisted electrosurgery (ES) using electrothermal energy, neutral argon plasma (NAP) using kinetic particle energy, or cold atmospheric plasma (CAP) using non-thermal biochemical reactions. In total, 8958 articles were identified, of which 310 were scanned, and 14 were included due to containing quantitative data on depths or volumes of tissues reached. Plasma-assisted ES devices produce a thermal effects depth of <2.4 mm. In turn, NAP effects remained superficial, <1.0 mm. So far, the depth and uniformity of CAP effects are insufficiently understood. These data are crucial to achieve complete treatment, reduce recurrence, and limit damage to healthy tissues (e.g., prevent perforations or preserve parenchyma). Upcoming and potentially high-gain applications are discussed, and deficits in current evidence are identified.

Automated summary

This review discusses the historical and future applications of plasma in gynaecology and evaluates the depths of (non-)thermal effects in female pelvic tissues. The study found that the depth of thermal effects for plasma-assisted electrosurgical devices relied on current dispersion in tissue and was less than 2.4 mm, while the depth for electrically neutral argon plasma remained superficial (<1.0 mm). The depth and uniformity of cold atmospheric plasma effects require further investigation.