Abstract
BackgroundSeroma is the most frequent postoperative complication following breast cancer surgery. Our aim was to evaluate the effect of the harmonic focus scalpel versus electrocautery in reducing seroma formation post-mastectomy and axillary clearance.MethodsA prospective randomized controlled trial study was conducted at the Department of Surgery of Suez Canal University Hospital from April 26th 2014 to 30th June 2016. Seventy-two women, in whom a mastectomy and axillary clearance for breast cancer were performed, were randomly allocated to either harmonic dissection (n = 36) or electrocautery (n = 36).ResultsThe mean operative time was significantly longer for harmonic dissection compared with electrocautery (2.63 ± 0.41 vs. 1.75 ± 0.26 h; p < 0.0001). In addition, a significantly smaller amount of intraoperative blood loss (69.4 ± 25.1 vs. 255.5 ± 41.6 ml; p = 0.002) and total drainage volume (1277.8 ± 172.5 ml vs. 3300 ± 167.5 ml; p = 0.002) were found in the harmonic group. Moreover, there was a significant reduction in the time of drain removal (10.9 ± 1.12 vs. 15.9 ± 1.44; p = 0.001) and the incidence of seroma formation after drain removal [8.3% vs 33.3%; p = 0.003] in the harmonic group compared with those in the electrocautery group.ConclusionHarmonic dissection technique leads to significant decreases in intraoperative blood loss, total drainage volume and postoperative seroma in terms of shorter drain duration with a minimal increase in the operative time and better quality of life. Here, we recommend the use of the harmonic dissection technique in mastectomy and axillary clearance.
Highlights
Seroma is the most frequent postoperative complication following breast cancer surgery
Electrocautery has been widely used for resection purposes in breast surgery, as it significantly reduces blood loss compared with conventional scalpel use; the use of electrocautery may increase the occurrence of seroma following modified radical mastectomy (MRM), as it causes thermal tissue damage in the skin flaps, leading to local inflammatory reaction, subdermal vascular plexus disruption, and incomplete lymphatic and vascular occlusion; these complications often contribute to a higher seroma morbidity rate [3]
Study hypothesis We hypothesised that the usage of harmonic dissection technique in modified radical mastectomy will decrease the incidence of seroma formation and other post-operative complications
Summary
Seroma is the most frequent postoperative complication following breast cancer surgery. Our aim was to evaluate the effect of the harmonic focus scalpel versus electrocautery in reducing seroma formation post-mastectomy and axillary clearance. Seroma is the most frequent postoperative complication following breast cancer surgery, with an incidence rate ranging between 15% and 85% [1]. Electrocautery has been widely used for resection purposes in breast surgery, as it significantly reduces blood loss compared with conventional scalpel use; the use of electrocautery may increase the occurrence of seroma following modified radical mastectomy (MRM), as it causes thermal tissue damage in the skin flaps, leading to local inflammatory reaction, subdermal vascular plexus disruption, and incomplete lymphatic and vascular occlusion; these complications often contribute to a higher seroma morbidity rate [3]. The harmonic scalpel has been extensively used in laparoscopic surgery for surgical dissection based on findings from its use in open surgery, namely, that it can significantly reduce blood loss and operative time [5]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
