Ultrasonic scalpel ablation for vaginal intraepithelial neoplasia occurring after hysterectomy

Purpose of investigation: This pilot study aimed to assess the feasibility and efficacy of ultrasonic scalpel ablation for vaginal intraepithelial neoplasia (VAIN) Grade 3 lesions occurring after hysterectomy for cervical malignancies. Materials and Methods: A total of 11 cases of VAIN 3 that occurred after hysterectomy for cervical in-situ and invasive carcinoma were treated using ultrasonic scalpel ablation. The clinical courses and treatment outcomes of the cases were retrospectively analyzed along with four cases that were treated using conventional CO2 laser vaporization. A review of related articles was conducted to compare the therapeutic efficacy and indications for various treatments. Results: In all of the cases, the procedure was conducted safely with no significant complications. After treatment, the cytology of the vaginal stump was normalized in 14 cases (93.3%). One patient’s cytology was not normalized; she was treated with a partial vaginectomy. Re-recurrence occurred in three of the four (75%) patients treated with CO2 laser vaporization and three of the 11 (27.3%) patients treated with ultrasonic ablation. All but one patient remained free of disease after the second treatment for VAIN. Conclusion: Ultrasonic ablation may be feasible and convenient and as effective as CO2 laser vaporization for the treatment of VAIN after hysterectomy.

Vaginal intraepithelial neoplasia (VAIN); Ultrasonic scalpel; Ablation; Hysterectomy; CO2 laser vaporization.

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