Ultrasonic Technology : A New Treatment Option for Anal Condylomata Acuminata

PURPOSE: Treatment options for anal and perianal warts caused by human papillomavirus include topical application of cytotoxic substances or immunomodulators and ablative procedures. The objective of this prospective study was the evaluation of the ultrasound-driven Harmonic® Scalpel (Ethicon Endo-Surgery, Norderstedt, Germany) for resection of anal and perianal condylomata acuminata. METHODS: Eight men and three women (age range, 26-72 years) with anal and perianal condylomata acuminata were treated by a Harmonic® Scalpel blade operating at a vibration frequency of 55.5 kHz and within a temperature range of 65°C to 120°C. Nine patients were treatment naive, and two patients had recurrent disease. Follow-up ranged from 4 to 26 months. RESULTS: Seven patients had perianal condylomata, two patients had exclusively intra-anal, and two patients had perianal and intra-anal warts. All condylomata were excised in a single-step procedure with complete clearing without injury of subepidermal layers. We observed no intraoperative or postoperative complications. No recurrences occurred during follow-up. CONCLUSIONS: The Harmonic® Scalpel has been an effective and safe method for the treatment of anal perianal human papillomavirus condylomata without recurrent warts. Subepidermal skin levels remained uninjured; thus, no complications or unsatisfactory cosmesis occurred.