{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T17:36:50Z","timestamp":1761845810694,"version":"build-2065373602"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T00:00:00Z","timestamp":1761782400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Competitive State Research Financing of the Expert Responsibility area of the Tampere University Hospital","award":["9AB108"],"award-info":[{"award-number":["9AB108"]}]},{"name":"the Finnish Society for Research in Gynecology & Obstetrics","award":["-"],"award-info":[{"award-number":["-"]}]},{"name":"the Finnish Society for Gynecological Surgery","award":["-"],"award-info":[{"award-number":["-"]}]},{"DOI":"10.13039\/501100004371","name":"Tampereen Yliopisto","doi-asserted-by":"publisher","award":["-"],"award-info":[{"award-number":["-"]}],"id":[{"id":"10.13039\/501100004371","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Electrothermal bipolar vessel sealing devices (EBVS) and ultrasonic devices (US) \u2013 collectively known as advanced hemostasis devices (AHDs) \u2013 are considered equally feasible in laparoscopic procedures. However, US devices have been demonstrated to be more susceptible to abnormal heat accumulation when activation cycles are rapidly repeated, causing results from laparoscopic procedures to be poorly translated to vulvar cancer surgery. In this study, we aimed to determine whether EBVS and US are comparable in terms of peri- and postoperative morbidity in vulvar cancer surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective single-center study comprised patients who underwent a primary vulvectomy, partial vulvectomy, or radical local resection with an AHD in Tampere University Hospital, Finland, in 2011\u20132023. Our primary outcome measure was the Clavien-Dindo grade, which measures the incidence and severity of postoperative complications in the early (30-day) postoperative period. Secondary outcome measures were blood loss, postoperative blood transfusions, operative time, the total volume of groin drain output, and length of hospital stay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eighty-six patients were included (EBVS n\u2009=\u200945, US n\u2009=\u200941). Postoperative complications (Clavien-Dindo grades II \u2013 V) were significantly less common in the EBVS group compared to the US group (60% vs 85% in the EBVS and US groups, respectively; p\u2009=\u20090.015). The difference was driven by a discrepancy in grade II complications (49% vs 71%), which consisted primarily of infections in both groups. In a multivariable regression analysis adjusting for the extent of surgery, the use of an EBVS device was independently associated with a lower likelihood of postoperative complications compared to US (aOR 0.3, 95%CI 0.1\u20130.9 for EBVS vs US; p\u2009=\u20090.030). Both the amount of operative blood loss (median (IQR) 50 (45\u2013200) ml vs 150 (88\u2013400) ml; p\u2009=\u20090.005) and length of hospital stay (median (interquartile range) 6 (4\u20138) vs. 8 (6\u201310) days; p\u2009=\u20090.002) were lower in the EBVS group, but surgical device did not independently predict the highest quartile of either variable. The amount of postoperative blood transfusions, operative time, or groin drain output did not significantly differ between the groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The data from this study suggests electrothermal bipolar vessel sealing devices could reduce early postoperative complications, especially those related to the surgical site, in vulvar cancer surgery compared to ultrasonic devices. Prospective studies are needed to ensure the generalizability of the results.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0335266","type":"journal-article","created":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T17:25:57Z","timestamp":1761845157000},"page":"e0335266","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Electrothermal bipolar vessel sealing devices are associated with lower rates of postoperative complications compared to ultrasonic devices in vulvar cancer surgery"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0342-0946","authenticated-orcid":true,"given":"Milla K.","family":"M\u00f6rsky","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ilkka S.","family":"Kaartinen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6907-1147","authenticated-orcid":true,"given":"Reita H.","family":"Nyberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,10,30]]},"reference":[{"issue":"11","key":"pone.0335266.ref001","doi-asserted-by":"crossref","first-page":"2174","DOI":"10.1002\/ijc.30900","article-title":"Vulvar cancer in high\u2010income countries: Increasing burden of disease","volume":"141","author":"Y Kang","year":"2017","journal-title":"Intl Journal of Cancer"},{"issue":"7","key":"pone.0335266.ref002","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1080\/14737140.2017.1337513","article-title":"Limiting the morbidity of inguinofemoral lymphadenectomy in vulvar cancer patients; a review","volume":"17","author":"A-FW Pouwer","year":"2017","journal-title":"Expert Rev Anticancer Ther"},{"issue":"2","key":"pone.0335266.ref003","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1016\/j.ygyno.2013.07.082","article-title":"A review of complications associated with the surgical treatment of vulvar cancer","volume":"131","author":"A Wills","year":"2013","journal-title":"Gynecol Oncol"},{"issue":"6","key":"pone.0335266.ref004","doi-asserted-by":"crossref","first-page":"1400","DOI":"10.1016\/j.ejso.2022.02.006","article-title":"Complications and risk factors in vulvar cancer surgery - A population-based study","volume":"48","author":"C Rahm","year":"2022","journal-title":"Eur J Surg Oncol"},{"issue":"3","key":"pone.0335266.ref005","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1006\/gyno.1995.1151","article-title":"The importance of the groin node status for the survival of T1 and T2 vulval carcinoma patients","volume":"57","author":"MP Burger","year":"1995","journal-title":"Gynecol Oncol"},{"issue":"7","key":"pone.0335266.ref006","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1016\/S1470-2045(10)70104-2","article-title":"Size of sentinel-node metastasis and chances of non-sentinel-node involvement and survival in early stage vulvar cancer: results from GROINSS-V, a multicentre observational study","volume":"11","author":"MH Oonk","year":"2010","journal-title":"Lancet Oncol"},{"issue":"3","key":"pone.0335266.ref007","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1016\/j.jmig.2013.01.014","article-title":"Comparative studies of energy sources in gynecologic laparoscopy","volume":"20","author":"KSK Law","year":"2013","journal-title":"J Minim Invasive Gynecol"},{"issue":"5","key":"pone.0335266.ref008","article-title":"Energy source instruments for laparoscopic colectomy","author":"S Tou","year":"2011","journal-title":"Cochrane Database Syst Rev"},{"issue":"13","key":"pone.0335266.ref009","doi-asserted-by":"crossref","first-page":"4414","DOI":"10.1245\/s10434-019-07806-w","article-title":"Comparing the Utility and Surgical Outcomes of Harmonic Focus Ultrasonic Scalpel with Ligasure Small Jaw Bipolar Device in Thyroidectomies: A Prospective Randomized Controlled Trial","volume":"26","author":"S-H Lee","year":"2019","journal-title":"Ann Surg Oncol"},{"issue":"6","key":"pone.0335266.ref010","doi-asserted-by":"crossref","first-page":"1918","DOI":"10.1245\/s10434-012-2849-6","article-title":"A systematic review and meta-analysis comparing the efficacy and surgical outcomes of total thyroidectomy between harmonic scalpel versus ligasure","volume":"20","author":"BH-H Lang","year":"2013","journal-title":"Ann Surg Oncol"},{"key":"pone.0335266.ref011","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/j.ijsu.2020.03.072","article-title":"Comparison of outcomes after differentiated thyroid cancer surgery performed with and without energy devices: A population-based cohort study using a nationwide database in Japan","volume":"77","author":"T Konishi","year":"2020","journal-title":"Int J Surg"},{"issue":"10","key":"pone.0335266.ref012","doi-asserted-by":"crossref","first-page":"2892","DOI":"10.1007\/s00464-012-2276-6","article-title":"Effectiveness of electrothermal bipolar vessel-sealing devices versus other electrothermal and ultrasonic devices for abdominal surgical hemostasis: a systematic review","volume":"26","author":"PF Janssen","year":"2012","journal-title":"Surg Endosc"},{"issue":"6","key":"pone.0335266.ref013","doi-asserted-by":"crossref","first-page":"3189","DOI":"10.1007\/s00464-021-08322-3","article-title":"Repeated partial tissue bite with inadequate cooling time for an energy device may cause thermal injury","volume":"35","author":"K Shibao","year":"2021","journal-title":"Surg Endosc"},{"issue":"9","key":"pone.0335266.ref014","doi-asserted-by":"crossref","first-page":"2541","DOI":"10.1007\/s00464-012-2229-0","article-title":"Safety and efficacy of new integrated bipolar and ultrasonic scissors compared to conventional laparoscopic 5-mm sealing and cutting instruments","volume":"26","author":"D Seehofer","year":"2012","journal-title":"Surg Endosc"},{"issue":"1","key":"pone.0335266.ref015","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.ejso.2022.08.030","article-title":"Ultrasonic scissors decrease postoperative bleeding complications in mastectomy: A retrospective multicenter cohort study on 728 patients","volume":"49","author":"A Tamminen","year":"2023","journal-title":"European Journal of Surgical Oncology"},{"issue":"6","key":"pone.0335266.ref016","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1016\/j.amjsurg.2011.06.051","article-title":"Preventing seroma formation after axillary dissection for breast cancer: a randomized clinical trial","volume":"203","author":"F Iovino","year":"2012","journal-title":"Am J Surg"},{"key":"pone.0335266.ref017","doi-asserted-by":"crossref","DOI":"10.1186\/s12893-018-0454-8","article-title":"Advanced hemostasis in axillary lymph node dissection for locally advanced breast cancer: new technology devices compared in the prevention of seroma formation","volume":"18","author":"C Gambardella","year":"2019","journal-title":"BMC Surg"},{"issue":"1","key":"pone.0335266.ref018","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s12893-017-0222-1","article-title":"Impact of the Ultrasonic scalpel on the amount of drained lymph after axillary or inguinal lymphadenectomy","volume":"17","author":"O Gi\u00e9","year":"2017","journal-title":"BMC Surg"},{"issue":"10","key":"pone.0335266.ref019","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1016\/j.ejso.2012.05.006","article-title":"Ultrasonic dissection versus electrocautery in mastectomy for breast cancer - a meta-analysis","volume":"38","author":"A Currie","year":"2012","journal-title":"Eur J Surg Oncol"},{"issue":"8","key":"pone.0335266.ref020","doi-asserted-by":"crossref","first-page":"1242","DOI":"10.1093\/jjco\/hyab083","article-title":"Clinical benefits of vessel sealing system (LigaSure\u2122) during surgery for soft tissue sarcoma: a propensity score matching analysis","volume":"51","author":"E Shimada","year":"2021","journal-title":"Jpn J Clin Oncol"},{"issue":"2","key":"pone.0335266.ref021","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1177\/1457496919828237","article-title":"Ligasure impact\u2122 might reduce blood loss, complications, and re-operation occurrence after abdominoplasty in massive-weight-loss patients: A Comparative Study","volume":"109","author":"S Giordano","year":"2020","journal-title":"Scand J Surg"},{"key":"pone.0335266.ref022","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.suronc.2020.08.011","article-title":"Reduced morbidity by using LigaSure compared to conventional inguinofemoral lymphadenectomy in vulvar cancer patients: A randomized controlled trial","volume":"35","author":"A-FW Pouwer","year":"2020","journal-title":"Surg Oncol"},{"issue":"3","key":"pone.0335266.ref023","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1245\/s10434-013-3369-8","article-title":"Harmonic scalpel versus electrocautery dissection in modified radical mastectomy: a randomized controlled trial","volume":"21","author":"S Khan","year":"2014","journal-title":"Ann Surg Oncol"},{"issue":"2","key":"pone.0335266.ref024","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"D Dindo","year":"2004","journal-title":"Annals of Surgery"},{"key":"pone.0335266.ref025","unstructured":"Findata. Producing anonymous results. Updated 4112024\u2009n.d. [accessed January 31, 2025]. https:\/\/findata.fi\/en\/services-and-instructions\/producing-anonymous-results\/"},{"issue":"1","key":"pone.0335266.ref026","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.ygyno.2022.07.017","article-title":"Unilateral inguinofemoral lymphadenectomy in patients with early-stage vulvar squamous cell carcinoma and a unilateral metastatic sentinel lymph node is safe","volume":"167","author":"WL Van der Kolk","year":"2022","journal-title":"Gynecologic Oncology"},{"issue":"3","key":"pone.0335266.ref027","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1016\/j.ygyno.2022.06.024","article-title":"Superficial versus deep inguinal nodal dissection for vulvar cancer staging","volume":"166","author":"J Mattson","year":"2022","journal-title":"Gynecol Oncol"},{"issue":"6","key":"pone.0335266.ref028","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1200\/JCO.2007.14.0566","article-title":"Sentinel node dissection is safe in the treatment of early-stage vulvar cancer","volume":"26","author":"AGJ Van der Zee","year":"2008","journal-title":"J Clin Oncol"},{"issue":"2","key":"pone.0335266.ref029","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.ygyno.2019.05.010","article-title":"Margin status revisited in vulvar squamous cell carcinoma","volume":"154","author":"NC Te Grootenhuis","year":"2019","journal-title":"Gynecol Oncol"},{"issue":"11","key":"pone.0335266.ref030","doi-asserted-by":"crossref","first-page":"2308","DOI":"10.1016\/j.ejso.2022.09.010","article-title":"The changing role for extended resections in an era of advanced radiotherapy techniques and novel therapies in gynaecological malignancy","volume":"48","author":"RD McBain","year":"2022","journal-title":"Eur J Surg Oncol"},{"issue":"2","key":"pone.0335266.ref031","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.ijgo.2008.07.004","article-title":"Harmonic scalpel versus conventional electrosurgery in the treatment of vulvar cancer","volume":"103","author":"A Pellegrino","year":"2008","journal-title":"Int J Gynaecol Obstet"},{"issue":"2","key":"pone.0335266.ref032","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/S0301-2115(00)00273-6","article-title":"Wound complications in patients with carcinoma of the vulva. Comparison between radical and modified vulvectomies","volume":"93","author":"A Leminen","year":"2000","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"3","key":"pone.0335266.ref033","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1002\/bjs.6901","article-title":"Comparison of lateral thermal spread using monopolar and bipolar diathermy, the Harmonic Scalpel and the Ligasure","volume":"97","author":"PA Sutton","year":"2010","journal-title":"Br J Surg"},{"key":"pone.0335266.ref034","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/j.jss.2016.06.077","article-title":"Ultrasonic, bipolar, and integrated energy devices: comparing heat spread in collateral tissues","volume":"207","author":"MK Applewhite","year":"2017","journal-title":"Journal of Surgical Research"},{"issue":"9800","key":"pone.0335266.ref035","doi-asserted-by":"crossref","first-page":"1396","DOI":"10.1016\/S0140-6736(11)61381-0","article-title":"Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study","volume":"378","author":"KM Musallam","year":"2011","journal-title":"Lancet"},{"issue":"1","key":"pone.0335266.ref036","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/SLA.0000000000001264","article-title":"Variation in Transfusion Practices and the Effect on Outcomes After Noncardiac Surgery","volume":"262","author":"ZM Abdelsattar","year":"2015","journal-title":"Ann Surg"},{"issue":"1","key":"pone.0335266.ref037","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1001\/archsurg.2011.790","article-title":"Surgical outcomes and transfusion of minimal amounts of blood in the operating room","volume":"147","author":"VA Ferraris","year":"2012","journal-title":"Arch Surg"},{"key":"pone.0335266.ref038","doi-asserted-by":"crossref","first-page":"3402137","DOI":"10.1155\/2019\/3402137","article-title":"Comparison between LigaSure\u2122 and Harmonic\u00ae in Laparoscopic Sleeve Gastrectomy: A Single-Center Experience on 422 Patients","volume":"2019","author":"N Velotti","year":"2019","journal-title":"J Obes"},{"issue":"31","key":"pone.0335266.ref039","doi-asserted-by":"crossref","first-page":"3786","DOI":"10.1200\/JCO.2011.41.2528","article-title":"Lymphatic mapping and sentinel lymph node biopsy in women with squamous cell carcinoma of the vulva: a gynecologic oncology group study","volume":"30","author":"CF Levenback","year":"2012","journal-title":"J Clin Oncol"},{"issue":"3","key":"pone.0335266.ref040","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1111\/jog.15103","article-title":"The giant steps in surgical downsizing toward a personalized treatment of vulvar cancer","volume":"48","author":"A Giannini","year":"2022","journal-title":"J Obstet Gynaecol Res"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0335266","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T17:26:03Z","timestamp":1761845163000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0335266"}},"subtitle":[],"editor":[{"given":"Eiji","family":"Kondo","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,10,30]]},"references-count":40,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10,30]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0335266","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,30]]}}}